Psoriatic arthritis

Treatments and drugs

Date updated: December 13, 2008
Content provided by MayoClinic.com

No cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability. Often, a multidisciplinary approach is used to treat both skin and joint symptoms.

Medications
Medications commonly used to treat psoriatic arthritis include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Drugs such as aspirin and ibuprofen (Advil, Motrin, others) may help control pain, swelling and morning stiffness, and they're usually the first treatment tried for psoriatic arthritis. Prescription NSAIDs provide higher potencies than do over-the-counter drugs. But all NSAIDs can irritate your stomach and intestine, and long-term use can lead to ulcers and gastrointestinal bleeding.

  Other potential side effects include damage to your kidneys, fluid retention and heart failure. In addition, NSAIDs may worsen skin problems. Still, these medications may be a good option for people with minor joint pain and stiffness.

• Corticosteroids. If you have mild psoriatic arthritis, your doctor might recommend corticosteroids to control infrequent joint pain flares. Corticosteroids can be taken orally, or they can be injected directly into aching joints. Corticosteroid injections provide almost immediate relief and improve range of motion - sometimes for months. But because injected steroids can cause damage, their use is usually limited.
• Disease-modifying antirheumatic drugs (DMARDs). Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic arthritis. But because DMARDs act slowly, you may not notice the effects for weeks or even months. For that reason, your doctor may prescribe a pain reliever, such as aspirin, in addition to a DMARD. Examples of DMARDs include sulfasalazine (Azulfidine) and methotrexate. The latter, particularly, has potentially serious side effects, including lung disease and liver problems. Taking folic acid with methotrexate can relieve certain side effects such as a sore mouth and an upset stomach.

• Immunosuppressant medications. These medications act to suppress your immune system, which normally protects your body from harmful organisms, but which attacks healthy tissue in people with psoriatic arthritis. Commonly used immunosuppressants include azathioprine (Imuran), cyclosporine (Sandimmune, Neoral) and leflunomide (Arava).

  Immunosuppressants can have potentially dangerous side effects and usually are used in only the most severe cases of psoriatic arthritis. Because they suppress the immune system, all such drugs can lead to anemia and an increased risk of serious infection. And many of them can cause liver and kidney problems.

• TNF-alpha inhibitors. Your doctor may recommend tumor necrosis factor-alpha (TNF-alpha) inhibitors if you have severe psoriatic arthritis. These drugs block the protein that causes inflammation in some types of arthritis. Drugs in this category include etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade). TNF-alpha inhibitors can improve signs and symptoms of psoriasis, as well. All carry a risk of serious side effects, however, including some that can be life-threatening. Be sure to discuss with your doctor whether the benefits you'll receive from these medications outweigh the risks. Keep in mind that these treatments, which must be injected, are very expensive, often costing thousands of dollars per treatment. If you and your doctor decide to use TNF inhibitors, check with your insurance company about coverage.

Surgery
Although surgery is rarely performed for psoriatic arthritis, your doctor may recommend some form of joint operation when other treatments fail to relieve your symptoms. Surgeons use various procedures to ease pain and restore mobility. Because these operations pose some risks, be sure you thoroughly discuss your options with your doctor.