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Treatments and drugs
By Mayo Clinic staffNo cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability. Medications used to treat psoriatic arthritis include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Disease-modifying antirheumatic drugs (DMARDs)
- Immunosuppressant medications
- TNF-alpha inhibitors
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Drugs such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, Anaprox, 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 gastrointestinal bleeding. Other potential side effects include damage to your kidneys, fluid retention, high blood pressure and heart failure. In addition, NSAIDs may worsen the skin problems associated with psoriatic arthritis.
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. Methotrexate (Trexall) is the most common DMARD used to treat psoriatic arthritis. However, it has potentially serious side effects, including lung, kidney and liver problems. In some studies, sulfasalazine (Azulfidine) has been shown to have a modest benefit in treating psoriatic arthritis.
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, Azasan)
- Cyclosporine (Sandimmune, Neoral, others)
- 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 and can improve signs and symptoms of psoriasis, as well.
Drugs in this category include:
- Adalimumab (Humira)
- Etanercept (Enbrel)
- Golimumab (Simponi)
- Infliximab (Remicade)
TNF-alpha inhibitors carry a risk of serious side effects, 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.
- Fitzgerald O. Psoriatic arthritis. In: Firestein GS, et al. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa.: W.B. Saunders Co.; 2008. http://www.mdconsult.com/das/book/body/223128990-5/1070709009/1807/528.html#4-u1.0-B978-1-4160-3285-4..10072-5_2607. Accessed Oct. 19, 2010.
- Gladman DD. Clinical manifestations and diagnosis of psoriatic arthritis. http://www.uptodate.com/home/index.html. Accessed Oct. 19, 2010.
- Psoriatic arthritis. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/psoriaticarthritis.asp. Accessed Oct. 19, 2010.
- Kleinert S, et al. Psoriatic arthritis: Clinical spectrum and diagnostic procedures. Clinics in Dermatology. 2007;25:519.
- Gladman DD. Pathogenesis of psoriatic arthritis. http://www.uptodate.com/home/index.html. Accessed Oct. 19, 2010.
- Mercier LR. Arthritis, psoriatic. In: Ferri FF. Ferri's Clinical Advisor 2011. Philadelphia, Pa.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/page.do?sid=1070709009&eid=4-u1.0-B978-0-323-07158-1..00003-1--s2020&isbn=978-0-323-07158-1&type=bookPage§ionEid=4-u1.0-B978-0-323-07158-1..00003-1--s2020&uniqId=223128990-6. Accessed Oct. 19, 2010.
- Gladman DD. Treatment of psoriatic arthritis. http://www.uptodate.com/home/index.html. Accessed Oct. 19, 2010.
- Chang-Miller A (expert opinion). Mayo Clinic, Scottsdale, Ariz. Nov. 2, 2010.
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