Alternative Treatments for Rheumatoid Arthritis & Osteoarthritis: What Works, What Doesn't
How to Find the Right Psoriatic Arthritis Treatment for Your Symptoms
Determining your specific needs will help your doctor find the right treatment options for you.
By Regina Boyle Wheeler
Medically Reviewed by Ross Radusky, MD
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Treatment for psoriatic arthritis is anything but one-size-fits-all. Quite the opposite, your treatment needs to be customized to your unique needs based on the severity of your symptoms, the joints affected, other health problems you may have, and what drugs may or may not be appropriate for you.
Researchers have found a connection between vitamin D deficiency and psoriatic arthritis. A study published in August 2015 in Arthritis Research & Therapy investigated 2,234 patients and linked vitamin D deficiency and chronic inflammatory rheumatic diseases, such as psoriatic arthritis. Among the patients studied, 775 had rheumatoid arthritis (RA), 738 had ankylosing spondylitis (AS), and 721 had psoriatic arthritis (PsA). Researchers found vitamin D deficiencies in blood samples in 40.5 percent of the RA patients, 39.7 percent of the AS patients, and 40.9 percent of the PsA patients. Still, it's unclear whether the vitamin deficiency was the cause of inflammation or a result of it.
Psoriatic arthritis affects up to 30 percent of people with the skin disease psoriasis. Most often, psoriatic arthritis symptoms start after psoriasis develops. Regardless of which comes first, it’s important to treat both your skin and your joint symptoms, possibly by working with a dermatologist and rheumatologist, says Yousaf Ali, MD, associate professor of medicine and chief of rheumatology at the Icahn School of Medicine at Mount Sinai Hospital in New York.
Treatment Options for Psoriatic Arthritis
With no cure for psoriatic arthritis, doctors focus on treating symptoms and trying to slow the progression of the disease. Treatment plans often include therapies that relieve skin lesions or joint pain, as well as medication that can treat both. This may include ointments and creams, phototherapy (using light), pain relievers, and systemic or “whole-body” medication.
Here are common approaches for symptoms of psoriatic arthritis and psoriasis:
- For Pain Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for mild pain, says Elyse Rubenstein, MD, rheumatologist at Providence Saint John’s Health Center in Santa Monica, California. For acute, severe pain, corticosteroid drugs can address symptoms and be used as a bridge until stronger, long-term medication starts working, she says.
- For Joint Damage Treating chronic pain, swelling, and redness may prevent joint damage from happening or getting worse. For mild disease, NSAIDs can be used alone or with stronger drugs called disease-modifying antirheumatic drugs (DMARDs). For moderate or severe psoriatic arthritis, your doctor may prescribe DMARDs or newer biologic medication, which targets specific substances that trigger inflammation. The goal is remission from psoriatic arthritis, which will allow you to participate fully in activities of daily living and prevent joint damage, Dr. Rubenstein says.
- For Skin Lesions “Topical treatments are applied to the skin and are usually the first treatment to try when diagnosed with psoriasis, especially in mild to moderate cases,” says Delphine Lee, MD, PhD, director of the Dermatological Center for Skin Health at Providence Saint John's Health Center in Santa Monica, California. In moderate to severe cases of psoriasis, doctors sometimes add phototherapy, which uses medical-grade ultraviolet light to slow the growth of out-of-control skin cells. Systemic therapies, like DMARDs and biologics, may also be prescribed. “All systemic therapies have more risk for side effects because all of your organs can be exposed to the drug,” Dr. Lee says. On the other hand, these drugs can do double duty to treat psoriasis and psoriatic arthritis symptoms. Ideally, your treatment will address and treat both skin and joint symptoms, Rubenstein says.
- During Pregnancy Pregnancy can have unpredictable effects on psoriatic arthritis. “About half of pregnant women with psoriatic arthritis experience symptom improvement, yet many get worse or stay the same," Dr. Ali says. You may need to stop taking certain drugs that are dangerous to a developing fetus and can’t be used during pregnancy or even before conception. Both women and men should discuss treatment options with a doctor before trying to conceive in order to keep the baby safe and skin and joint symptoms in check.
Additional Management Strategies for Skin and Joint Symptoms
Beyond medical treatment, other approaches can help almost everyone with psoriatic arthritis. Ali says controlling stress is important to managing symptoms. He suggests trying relaxation techniques, such as deep breathing, yoga, and meditation. "The most common trigger for inflammatory skin conditions is emotional stress," says Lee.
While there’s no way to completely prevent psoriatic arthritis, exercising, eating well, and maintaining a healthy weight can help protect your joints and your overall health. “It’s also important to see a doctor early, because mild psoriatic arthritis is easier to treat than chronic, untreated disease,” Rubenstein says.
Finally, it’s important to always follow your treatment plan as prescribed. You and your doctor can work together to find a regimen to treat all of your symptoms and minimize the side effects.
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