What Is the Best Treatment for Psoriatic Arthritis?

Reviewed on 6/7/2021

While there is no cure for psoriatic arthritis, there are treatments available to relieve symptoms and prevent further joint damage. Treatment depends on how mild or severe the condition is, which includes over-the-counter and prescription nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, disease-modifying antirheumatic drugs (DMARDs)  topical treatments, and immunosuppressants.
While there is no cure for psoriatic arthritis, there are treatments available to relieve symptoms and prevent further joint damage. Treatment depends on how mild or severe the condition is, which includes over-the-counter and prescription nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections, disease-modifying antirheumatic drugs (DMARDs) topical treatments, and immunosuppressants.

Psoriatic arthritis is a type of inflammatory arthritis that can develop in patients who have psoriasis, a chronic autoimmune skin condition that causes rapid skin cell growth and renewal. Psoriatic arthritis is different from other forms of arthritis in that it involves the skin and it affects the joints differently. 

There is no cure for psoriatic arthritis. The goal of treatment is to relieve symptoms and prevent further joint damage. The best treatment for psoriatic arthritis depends on the severity of the condition and how many joints are affected. 

For mild psoriatic arthritis, medications to treat pain and inflammation may be used such as those listed in the table below.

Drugs for Mild Psoriatic Arthritis
Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
Over-the-counter (OTC)
  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve)
  • Aspirin
Prescription
  • Celecoxib (Celebrex)

Treatment for more severe cases of psoriatic arthritis may include those listed in the table below.
Treatments for Severe Psoriatic Arthritis
Treatment Type Examples
Corticosteroids
  • Injections administered into the joints
Disease-modifying antirheumatic drugs (DMARDs)
  • Hydroxychloroquine (Plaquenil)
  • Methotrexate (Rasuvo, Otrexup, Xatmep, Trexall)
  • Sulfasalazine (Azulfidine EN-tabs, Azulfidine)
  • Azathioprine (Azasan)
  • Apremilast (Otezla) 
  • Leflunomide (Arava)
Antitumor necrosis factor (TNF) agents (also called biologics)
  • Ustekinumab (Stelara) 
  • Abatacept (Orencia) 
  • Secukinumab (Cosentyx) 
  • Ixekizumab (Taltz)
  • Tofacitinib (Xeljanz) 
Topical treatments for psoriasis symptoms
  • Retinoid and steroid creams
  • Prescription vitamin D creams
  • Over-the-counter or prescription salicylic acid creams, gels, and shampoos

Immunosuppressants 

  • Cyclosporine (used for severe cases that do not respond to other systemic treatments)

What Are Symptoms of Psoriatic Arthritis?

Symptoms of psoriatic arthritis include:

  • Skin rash (psoriasis)
  • Red patches of skin with silvery scales (plaques)
    • Commonly appears on the scalp, elbows, knees, and around the ears
  • Skin redness and warmth 
  • Scaly and itchy skin
  • Thickening skin
  • Joint pain, swelling, and stiffness
    • Often on one side of the body
    • Pain is worse in the morning or after resting
    • Can affect any joint, but commonly occurs in large joints of lower extremities such as the knees and ankles 
  • Pain and stiffness of the neck and lower back
  • Back, hip, and shoulder pain
  • Reduced range of motion in the joints
  • Fatigue
  • Heel pain and foot pain 
  • Sausage-like swelling of fingers and/or toes
  • Nails separate from nail bed
  • Pitted, crumbling nails
  • Eye inflammation such as pink eye (conjunctivitis)

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What Causes Psoriatic Arthritis?

The cause of psoriatic arthritis is not known, but it is thought that genetic, immunologic, and environmental factors play a role. 

About forty percent of people with psoriatic arthritis have family members with psoriasis or psoriatic arthritis. 

How Is Psoriatic Arthritis Diagnosed?

Psoriatic arthritis is diagnosed with a trip to the doctor. The physician will go over your patient history and give you a physical examination. You will also take tests to help diagnose psoriatic arthritis or to rule out other conditions that can mimic psoriatic arthritis, such as: 

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Reviewed on 6/7/2021
References
https://www.psoriasis.org/

https://www.niams.nih.gov/Health_Info/Psoriatic_Arthritis/default.asp

https://www.uptodate.com/contents/psoriatic-arthritis-beyond-the-basics

https://creakyjoints.org/

https://www.arthritis.org/