Psoriatic arthritis may be a frustrating condition with no cure, but a diagnosis doesn’t necessarily mean you’ll experience terrible symptoms like joint pain every night. The right psoriatic arthritis medications can put the disease into remission, meaning you have virtually no symptoms, according to the Mayo Clinic.
Psoriatic arthritis is a form of arthritis that’s more likely to develop in people who have psoriasis (a skin condition that causes scaly patches and discomfort like itching) or a family history of psoriasis. It commonly causes joint pain in your fingers, toes, wrists, knees, ankles, or lower back. Left untreated, the autoimmune disorder can lead to permanent joint damage, which is why early care is so important, according to the Mayo Clinic. It’s helpful to understand your options so you can work with your doctor to create a plan that suits your needs.
There’s no one-size-fits-all solution to treating psoriatic arthritis—rather, deciding to use any particular medication is a careful balance of the potential benefits versus risks to your body. Ultimately, there is no magic medication that treats the disease without side effects, says David M. Wanalista, D.O., who specializes in rheumatology at Atlantic General Hospital. “There may be bumps in the road as you treat psoriatic arthritis,” he tells SELF.
However, there are several promising medications that may reduce symptoms and protect your body from long-term damage. Choosing the right psoriatic arthritis medication depends on the severity of the disease, the number of affected joints, and whether your skin is affected by psoriatic arthritis. Keep in mind you may need to take a combination of treatments to alleviate your symptoms. Over time, your plan may evolve. “Medication that was working at first may lose effectiveness over time, and, in some cases, the disease does become more active, and so a change in treatment may be necessary,” Eric M. Ruderman, M.D., professor of medicine in the rheumatology division at Northwestern University Feinberg School of Medicine, tells SELF. Here are a few types of psoriatic arthritis treatment to know.
Non-steroidal anti-inflammatory drugs (NSAIDs)
You may already have one common treatment for psoriatic arthritis in your medicine cabinet: Non-steroidal anti-inflammatory drugs. These mild pain relievers, like ibuprofen and naproxen sodium (or Aleve), are available without a prescription (except for more powerful NSAIDs that do require a prescription), and work by blocking inflammation-causing compounds, says Kristi Kuhn, M.D., Ph.D., rheumatologist with UCHealth Rheumatology Clinic–Anschutz Medical Campus.
NSAIDs are best reserved for people with mild symptoms, and they won’t prevent joint damage or stop the disease from becoming worse over time, according to NYU Langone Health. It’s worth noting that NSAIDs are typically meant for short-term use, so you’ll want to work with your doctor to determine the best frequency and dosage for you.
Disease-modifying anti-rheumatic drugs (DMARDs)
DMARDs are the most common medications used to treat psoriatic arthritis, according to NYU Langone Health. Up to 30 percent of 80 people treated with DMARDs sustained remission of their psoriatic arthritis, according to a 2019 study published in Rheumatology and Therapy.
This treatment helps prevent inflammation from spreading through your body—ultimately slowing the progression of the disease. Doctors often rely on a weekly tablet of methotrexate as the first-choice DMARD for psoriatic arthritis. Be aware that this drug may contribute to liver damage, so you may need to cut back on alcohol and get regular blood tests to monitor your health, explains Joseph F. Merola, M.D., M.M.Sc., associate professor of dermatology at Harvard Medical School and associate physician at Brigham and Women’s Hospital. Luckily, there are other forms of DMARDs, such as JAK inhibitors, that may be an option if methotrexate isn’t effective enough. (“JAK” refers to Janus kinase, an enzyme related to inflammation.)
Depending on your situation, your doctor may recommend taking DMARDs alone or with another drug.
Biologics
Biologics are a type of DMARD doctors use to treat moderate to severe psoriatic arthritis. These drugs can be more expensive and invasive to use than other treatments (some need to be self-injected or administered through an IV drip at a doctor’s office). But they also come with one major upside: Some biologics can reduce the severity of the disease in up to 50 percent of the patients who try them, according to a 2016 study published in The Journal of Rheumatology.
There’s a variety of biologics available, including TNF inhibitors that block activity from tumour necrosis factor, a protein responsible for inflammation. Dr. Wanalista tells SELF these “have revolutionized the treatment for psoriatic arthritis.”
“When started early in the disease process, [TNF inhibitors] can preserve joint space and help patients achieve disease remission,” Sana Makhdumi, M.D., rheumatologist at Baylor Scott & White Hospital, tells SELF.
Biologics work by suppressing parts of your immune system, so you have a greater risk of developing infections, like the common cold, when taking these drugs.
Small molecule medications
These newer medications target the parts of the immune system that cause inflammation and experts often recommend them for people who don’t respond to other treatments. Some DMARDs, such as JAK inhibitors, are also small molecule medications.
The medications enter your cells and block substances that cause inflammation in your body. Generally, these are affordable compared to other types of medications and have simple dosing instructions.
How to know which psoriatic arthritis medication is best for you
The right therapies can ease pain, optimize your quality of life, and protect your joints from long-term damage. But achieving this mission is complex, and no two patients have the same treatment needs over the course of their disease, says Dr. Kuhn.
It’s important to work with a rheumatologist who can assess the severity of your condition and develop a plan for you, says Dr. Ruderman.
“While treatment is often focused on achieving the best long-term outcomes, it is important that your doctor know which particular manifestations are most bothersome for you,” he says.
Your preferences are important, too—especially when it comes to how the treatment is administered, says Victoria Seligman, M.D., M.P.H., rheumatologist with the UCHealth Rheumatology Clinic in Denver. A biologic might not be the best option if you hate needles, for instance. Likewise, you should tell your doctor if you have trouble following a daily pill schedule.
Once you and your care team have weighed the risks and benefits of a potential treatment and you’re ready to get started, Ana-Maria Orbai, M.D., M.H.S, director of the psoriatic arthritis program at Johns Hopkins University School of Medicine, recommends tracking your psoriatic arthritis symptoms so you can look for changes during treatment.
Overall, stay persistent and try to advocate for yourself. “The physician and patient should work together as a team. Don’t take a single treatment recommendation as an option. Push and ask for alternatives. You have a right to that information,” says Dr. Makhdumi.
https://www.self.com/story/psoriatic-arthritis-medication
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