Psoriatic Arthritis

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Treatment

Patients who have psoriatic arthritis require regular physical examinations and imaging tests (e.g., x-rays) to monitor disease progression. There is no cure for the disorder, and the goals of treatment are to reduce inflammation and relieve symptoms. Exercise and adequate amounts of rest are important aspects of treatment and help reduce joint inflammation, pain, and stiffness.

Psoriasis is often treated using corticosteroids, which are available in creams, ointments, gels, lotions, and foams. These medications, which are applied topically to the skin, are often used for short-term management and in combination with other topical therapies. Corticosteroids may cause thinning of the skin and progressive resistance and they are usually discontinued gradually.

Prescription and over-the-counter tar medications also may be effective. These preparations are available in shampoos, as additives for the bath, and as anthralin (tar-like) creams.

Most patients with psoriasis experience improvement with sensible exposure to sunlight and the condition often improves during the summer months. Sometimes artificial ultraviolet light is administered in the physician's office. In these cases, the patient is exposed to increasing amounts of ultraviolet B (UVB) or ultraviolet A (UVA) rays.

UVA rays are used with an oral or topical substance called psoralen, which makes the skin more sensitive to treatment and improves its effectiveness. This treatment is called psoralen plus UVA (PUVA).

Treatment for joint inflammation caused by psoriatic arthritis often depends on the type and severity of the condition. In most cases, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g., Advil®, Motrin®) are used. NSAIDs may cause gastrointestinal side effects, including abdominal pain, nausea, and bleeding in the stomach.

Corticosteroid injections may be administered to help reduce severe joint pain and stiffness.

Newer medications, such as disease-modifying anti-rheumatic drugs (DMARDs; e.g., methotrexate, hydroxychloroquine), sulfasalazine, and cyclosporine may be used to treat severe joint pain, when other treatments are ineffective.

These drugs have been shown to reduce inflammation, but they do not affect progression of the disease. They may be used in combination with an NSAID or a corticosteroid to reduce symptoms and inflammation. Side effects may be severe and include kidney damage and high blood pressure (hypertension).

The biologic response modifier, etanercept (e.g., Enbrel®) may be effective in patients over the age of 18 who have psoriatic arthritis. Side effects of this medication include redness, pain, and itching at the site of the injection.

Prognosis

The prognosis (expected outcome) for patients who have psoriatic arthritis depends on a number of factors, including the following:

• Age of onset (early onset may indicate a worse prognosis)
• Evidence of bone erosion and new bone formation (indicates severe disease)
• Family history of arthritis (may indicate a severe form of the disease)
• Gender (may be more severe in women)
• Presence of certain antibodies (may affect disease progression)
• Severity of skin and nail involvement (indicate a worse prognosis)
• Type (e.g., asymmetric, symmetric, psoriatic spondylitis)

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