Treatment of Psoriatic Arthritis.

As explained in psoriasis, there is no cure for psoriasis as also for arthritis psoriasis. Treatment aims to control the symptoms and complications, and ease up the patient’s life. Early treatment is important as this disease can be disabling due to joint destruction which it causes.

Since skin psoriasis and psoriatic arthritis exist together in most cases, treating symptoms of both becomes necessary. Treatment of psoriasis explains the cures prescribed for psoriasis.

More posts on psoriatic arthritis.

1) What is psoriatic arthritis. 2) Types of psoriatic arthritis. 3) Symptoms of psoriatic arthritis 4) Causes, risks and complications 5) Diagnosis of psoriatic arthritis. 6) Treatment of psoriatic arthritis. 7) Self care and home remedies.

Treating Psoriatic Arthritis.

The following medications are used to treat psoriatic arthritis.

• Non steroidal anti-inflammatory drugs (NSAIDs).
• Disease-modifying antirheumatic drugs.
• Immunosuppressant medicines
• Biological modifiers or TNF-alpha  inhibitors.

Besides medications from your physician, services of a rheumatologist, physiotherapist, occupational therapist and podiatrist may be required.

1) Non steroidal anti-inflammatory drugs (NSAIDs)

This is the first line of treatment for psoriatic psoriasis. Drugs such ibuprofen and naproxen are given to reduce the pain, swelling and stiffness of the joints. These may be followed by more potent drugs such as diclofenac, indomethacin and etodolac, if required.

In some patients, NSAIDs  can cause irritation of the stomach and the intestine and long term use can result in gastrointestinal bleeding. Other more serious side effects include peptic ulcer, renal toxicity, cardiac toxicity, fluid retention and hypertension.

However, many doctors prescribe Cytotec and omeprazole to protect the GI tract. Not everyone will need these medicines but any symptoms reflecting these side effects should be looked for.

2) Steroids.

Prednisolone is the steroid used to control the severe inflammation which could not be done with NSAIDs. It can be given orally or, in more severe and resistant cases, it can be injected directly into the joint or muscle to reduce the infection. Steroids are given in the minimal required doses and tapered off gradually as they are associated with serious side effects such as diabetes, osteoporosis, cataract, joint weakness and joint weakness. These steroids are different from the anabolic steroids that are used to build muscle and which are banned in competitive sports.

3) Disease-modifying antirheumatic drugs (DMARDs).

Besides controlling the pain, swelling and stiffness in the joints, these drugs also stop the progressive joint destruction which occurs in psoriatic arthritis. They are therefore indicated in cases which do not respond to NSAIDs and where NSAIDs do not control joint damage.

The only disadvantage is that these drugs act very slowly and it may take weeks or even months to see improvements.

Methotrexate is the commonly used DMARD. It has side effects which include kidney, liver and lung damage. It is strictly contraindicated in pregnancy.  Sulfasalazine is another drug which is used and shows some modest benefits.

4) Immunosuppressant medicines.

These are given to suppress the immune system which is responsible for psoriasis and psoriatic arthritis. See causes of psoriasis and psoriatic arthritis. As a result of the suppressed immunity, your body becomes vulnerable to infections and diseases. These drugs are therefore reserved for use only in severe cases of psoriatic arthritis. They also cause damage to the liver and kidneys.

Commonly used immunosuppressants include

• Cyclosporines (Sandimmune and Neoral.),
• Azathioprine ( Azasan, Imuran)
• Leflunomide (Arava).

5) Biological response modifiers or TNF-alpha inhibitors.

These are a new type of treatments  which belong to a class of drugs called Biologics. They have been developed through the medical science of genetics using DNA technology. They are basically manufactured proteins which act by focusing on the specific function of the immune system which leads to psoriasis and not the whole immune system.

Their route of administration is either intramuscular or intravenous.

Biologics include the following names.

• Alefacept (Amevive). This drug acts by decreasing the number activated T cells which are the main reason of psoriasis.
• Etharnecept (Enbrel)
• Infliximab (Remicade)
• Ustekinumab ( Stelera).

Etharnecept, Infliximab and Ustekinumab belong to the class of biologics which are TNF alpha blockers (Tumor necrosis factor). TNF are proteins which cause tumor cell necrosis and are pro inflammatory agents. TNF alpha blockers block the action of TNF.

• Efalizumab (Raptiva). This drug acts by blocking the activation of T cells and their migration to the skin. It has, however been withdrawn by the manufacturer in 2009.

These drugs have been associated with blood and nervous system disorders and certain cancers. More details are given under biologics.

6) Surgery for Psoriatic Arthritis.

In cases where the joint destruction has been much, joint replacement surgery is done to alleviate the pain, correct the joint disfigurement and increase the performance of the joint.

Related posts:

1. Psoriatic Arthritis.
2. Types of Psoriatic Arthritis.
3. How is Psoriatic Arthritis Diagnosed.
4. Psoriatic Arthritis Causes, Risk Factors and Complications.
5. Living with Psoriasis and Psoriatic Arthritis.
6. Symptoms and Signs of Psoriatic Arthritis.
7. Psoriatic Arthrtis|Self Care and Home Remedies.
8. Topical and Systemic Treatments for Mild and Severe Scalp Psoriasis.