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What is the Right Treatment for PsA?

We are here to help you navigate your psoriatic arthritis treatment options.

Symptoms of psoriatic arthritis (PsA) can range from mild to severe. [1] Without treatment, the disease can become disabling due to progressive and irreversible joint damage, which can lead to a reduced quality of life. [2] [3] [4] PsA is also associated with several health conditions or comorbidities that need to be monitored and that may also require treatment. [3] [5] [6]

While we still do not know what the best treatment is for a specific patient in terms of efficacy and safety, says Arthur Kavanaugh, M.D., there are a growing number of options to consider. [1] [3] [6] [7] Choosing a treatment comes down to which domains of psoriatic arthritis are active – and of concern to the patient – as well as what other therapies have been tried, and whether comorbid conditions are present that might impact choice of therapy, explains Dr. Kavanaugh, a professor of medicine and director of the Center for Innovative Therapy at University of California San Diego.

Treatment is aimed at reducing disease severity. [2] [3] Patients will have regular follow-ups with a rheumatologist to assess treatment and adjust as necessary. [3] [4]

“The goal is to get patients to how they felt before they were impacted by PsA,” Dr. Kavanaugh says.

Advances in the understanding of PsA have enabled the development of many new targeted treatments that aim to improve the signs and symptoms of disease, as well as minimizing joint damage and optimizing quality of life. [1] [3] [6]

A variety of drug and nondrug options are available to reduce pain, preserve joint range of motion, and help in stopping or slowing disease progression. [1] [2] [6] Treatments range from oral over-the-counter medications that reduce inflammation, pain, and swelling to injectable biologics and biosimilars (most are not yet available in the United States) that aim to mediate specific functions of the immune system thought to be causing inflammation and joint damage. [2] [6] [8]

Types of Treatments

If the disease is mild, you may initially require only a nonsteroidal anti-inflammatory drug (NSAID), such as over-the-counter ibuprofen or naproxen. [2] [9] Other stronger NSAIDs are available by prescription. [10] Serious side effects could include stomach irritation or upset, heart problems, and liver and kidney damage. [10]

If your disease is more advanced or doesn’t respond to NSAIDs, disease-modifying anti-rheumatic drugs (DMARDs) may be prescribed. [2] [9] These treatments try to slow or stop disease progression either by suppressing the entire immune system or by targeting specific parts of the immune system that lead to inflammation and disease. [6] They may be taken alone or in combination, and by mouth or through injection or infusion. You can find out more about these medications here.

When PsA is more advanced, or NSAIDs and conventional DMARDs are no longer effective, your physician may prescribe biologics or biosimilars. [2] [9] These include tumor necrosis factor-alpha inhibitors, interleukin inhibitors, phosphodiesterase-4 inhibitors, and janus kinase inhibitors, each of which targets a different pathway of the immune system to reduce inflammation and limit disease progression. [2] [3] [6]

Biologics and biosimilars may be taken by mouth or given through injection or infusion. You can find an up-to-date list of available biologics at psoriasis.org, where you can also find more information on biosimilars, which may become available in the United States within a couple of years. Side effects can vary and may include infection due to immune suppression. [10] [11] Your rheumatologist will discuss the risks specific to each therapy and the ways in which you will be monitored.

Depending on the treatments – some of which require more detailed monitoring – patients generally follow up with a rheumatologist every three months, Dr. Kavanaugh says.

Other Procedures and Nondrug Treatments

In addition to these drug-based therapies, Dr. Kavanaugh says he suggests nondrug alternatives, such as physical and occupational therapy, weight loss, and general healthy living. Physical and occupational therapy can ease joint pain and help to extend range of motion. [2] Lifestyle modifications that may also help to minimize symptoms include exercising regularly, limiting alcohol consumption, and stopping smoking. [12] [13]

Depending on the extent of the disease, steroid injections can help to reduce joint inflammation. [2] [10] For patients with more severe joint damage, joint replacement surgery may be an option. [10]

It’s important to work with a rheumatologist, who can help you identify the right treatment plan for your particular symptoms. [1] [4] For help finding a rheumatologist near you, contact the National Psoriasis Foundation Patient Navigation Center.

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Author

Heather Onorati

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Freelance writer

References

1.  National Psoriasis Foundation. About psoriatic arthritis. https://www.psoriasis.org/about-psoriatic-arthritis/.

2. Singh JA, Guyatt G, Ogdie A, et al. 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Care Res. 2019; 71(1): 2–29. doi:10.1002/acr.23789.

3.  Al Rayes H, Alazmi M, Attar S, et al. Consensus-based recommendations on the diagnosis, referral and clinical management of patients with psoriatic arthri-tis. Rheumatol Int. 2022; 42(3): 391–401. doi:10.1007/s00296-021-05029-5.

4. National Psoriasis Foundation. Why treat psoriatic arthritis? https://www.psoriasis.org/why-treat-psoriatic-arthritis/.

5. National Psoriasis Foundation. Related conditions of psoriatic arthritis. https://www.psoriasis.org/psa-related-conditions/.

6. Gossec L, Baraliakos X, Kerschbaumer A, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020; 79: 700–712. https://ard.bmj.com/content/79/6/700.1.

7.  National Psoriasis Foundation. Treatment & care. https://www.psoriasis.org/treatment-and-care/.

8. Mease PJ. New treatments for PsA meet targeted therapy goals. Nat Rev Rheumatol. 2021; 17(2): 77–78. doi:10.1038/s41584-020-00561-3.

9. American College of Rheumatology. Psoriatic arthritis. https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Psoriatic-Arthritis.

10. Mayo Clinic. Psoriatic arthritis. https://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/diagnosis-treatment/drc-20354081.

11. Kamata M, Tada Y. Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review. Int J Mol Sci. 2020; 21(5): 1690. doi:10.3390/ijms21051690.

12. National Psoriasis Foundation. Complementary and integrative medicine. https://www.psoriasis.org/complementary-and-integrative-medicine/.

13.  Elmets C, Korman N, Prater EF, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis. J Am Acad Dermatol. 2018. jaad.org/article/S0190-9622(20)32288-X/fulltext.

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