Published on Apr 3, 2012
Prevent joint damage, and ease the pain caused by psoriatic arthritis.
What is Psoriatic Arthritis? (Part 1 of 3) | HealthiNation
Living with Psoriatic Arthritis (Part 2 of 3) | HealthiNation
There are a number of treatments available to ease the joint pain and stiffness that comes with psoriatic arthritis. While there is no cure yet, these options should making living with psoriatic arthritis easier.
Depending on the severity of your condition, you may be prescribed oral or topical medications, or possibly injections. For the best results, you will want to follow your doctor's instructions closely. If you are still experiencing pain after using the treatments for at least a few weeks, let your doctor know. He or she may want to change your program.
If your condition is considered mild, your doctor will most likely prescribe non-steroidal anti-inflammatory drugs, known as NSAIDs for short. These include over-the-counter drugs such as aspirin, ibuprofen, and naproxen, as well as prescription strength versions called COX-2 inhibitors. COX-2 inhibitors are less likely to cause gastrointestinal, or stomach pain and may have fewer side effects.
All NSAID medications must be taken continuously for several weeks before their effectiveness can be determined. If the initial dose does not improve symptoms, your doctor may gradually increase the dose or switch you to another drug.
If non-steroidal treatments still don't work, your doctor may use certain steroids. Glucocorticoids can reduce pain and suppress inflammation when injected directly into affected joints. Glucocorticoid injections have fewer side effects than oral glucocorticoids, which can actually cause a severe form of skin psoriasis in some people.
Another type of treatment uses disease-modifying anti-rheumatic drugs, or DMARDs. The most common are methotrexate or MTX, or leflunomide, also called LEF.
MTX reduces excessive production of skin cells and is often recommended for people with multiple swollen joints. MTX is usually taken orally once a week. If larger doses are needed, it can be given by injection. You or a family member may learn how to administer the shot so that you don't have to go to the doctor every time you need a dose.
If methotrexate is not working for you, or you are experiencing side effects, your doctor may suggest leflunomide, or LEF. LEF can improve both skin and joint disease symptoms, but is only effective in about 40 percent of people with psoriatic arthritis.
While these medications may alleviate your symptoms, none of them have been proven to prevent the progression of damage caused by the condition.
If the DMARD options do not provide relief, there is another category of drug called tumor necrosis factor inhibitors—or TNF inhibitors. These are also called biologic drugs and include etanercept, adalimumab, and infliximab. Biologic agents usually work quickly, often within a couple of weeks and may be used alone or in combination with the other medications mentioned above.
Lastly, an immunosuppressant, cyclosporine, may also be used to treat severe psoriasis and psoriatic arthritis. It is not used as often as the TNF inhibitors and it may take three to four months before a response is seen. It also may work better in combination with methotrexate.
It is important to know that any medication comes with the risk of side effects. Learn the side effects of the drugs you are taking. For example, NSAIDs can cause stomach pain, or even ulcers and bleeding over time. Steroids may increase your risk of infections; methotrexate can cause liver toxicity, lung disease and bone marrow suppression; and leflunomide can cause diarrhea and elevated liver enzymes. These are just some of the possible side effects—every person will have a unique experience with each drug. Talk to your doctor about your concerns, and of course, if you experience anything that seems unusual, share it with your doctor.
Psoriatic arthritis can be painful and frustrating. But, there are many treatments available. Work with your doctor to find the right one for you... so you can manage the condition well.
Cantini F, Niccoli L, Nannini C, Kaloudi O, Bertoni M, Cassara E. Psoriatic arthritis: a systematic review. Int J Rheum Dis. 2010 Oct;13(4):300-17. doi:10.1111/j.1756-185X.2010.01540.x.
mbe AM, Maini RN, et al. Patient information: arthritis and exercise. UpToDate, 2011. Accessed August 8, 2011 at http://www.uptodate.com/contents/pati....)
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