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What can I do about Psoriatic Arthritis (PsA)?
Being diagnosed with a chronic disease like PsA can be a little scary. The first thing is don’t panic. Although you might have been diagnosed with PsA, you are not alone. Luckily, there are effective treatments available. Even if they don’t cure PsA, they can make living with the condition much more comfortable.
If you have PsA or think you may have PsA, your family doctor should refer you to a rheumatologist. A rheumatologist is a specialist doctor who is an expert in treating arthritis. This type of doctor is in the best position to help you manage your condition. Many people with inflammatory types of arthritis who see their rheumatologist regularly benefit from the highest level of care. It can also be a good idea to consult a dermatologist to treat your skin if your psoriasis is severe.
One thing to remember about PsA and other types of inflammatory arthritis is that chronic (long-term) inflammation is not good for the body. We now know that having PsA or other types of inflammatory arthritis is linked to heart disease. That means people with PsA have a higher chance of developing heart disease than people without PsA. So if you have PsA, make sure you do everything you can to reduce your risk of heart disease. The first thing you should do is to make sure your arthritis is treated. Other things include keeping your blood pressure and cholesterol at healthy levels. If you have diabetes, keep your blood sugar under control. And if you are a smoker, quitting can be one of the best things you can do for your overall health.
Here are some recommendations on what you should do if you have PsA:
- Learn as much as you can about this disease. Education is very powerful and we’ve aimed to develop this RheumInfo website to be accessible and easy to understand for everyday people living with PsA and other forms of inflammatory arthritis
- Attend your rheumatologist appointments regularly
- Get your blood tests done as suggested by your rheumatologist
- Learn about the medications used to treat PsA. The RheumInfo website has many interactive and valuable tools to help you understand these medications and their impact on your disease
Treatment of Psoriatic Arthritis (PsA)
People with PsA can lead active and productive lives with the right kinds of treatment. There are a number of effective treatment options available. These can help to decrease your joint pain and increase your joint mobility. Some treatments can also help relieve your psoriasis.
There are both medication and non-medication therapies to treat PsA. For example, exercise and joint protection are non-medication approaches to treating PsA. There are also several medications you can take to control your PsA. Whatever treatment approach you choose it is essential to remember two key points: treat PsA early and treat it aggressively.
Why is it important to treat PsA early?
Remember, PsA can eventually destroy the joints if it is not adequately controlled. The goal of treatment is to protect the joints before PsA causes permanent damage. Once the damage from PsA is done it cannot be reversed with medicine.
Think of it like this: the inflammation caused by PsA is like a fire burning in your joints. If you were sitting in your living room and you noticed a fire on the stove, you would want to put it out right away before it spread. You wouldn’t say “let’s wait a little bit” until the fire spreads to the ceiling before trying to put it out. With PsA, we want to put out the fire in your joints as quickly as possible, before permanent damage is done. We also want to treat PsA before it starts to affect other joints and other parts of the body.
Why is it important to treat PsA aggressively?
As we’ve said before, PsA can cause permanent damage if it is not treated and controlled. This can happen even if the pain and discomfort of PsA is not severe. In some people, joint damage can occur quickly. So we want to get the inflammation under control as soon as possible before permanent damage occurs. The right treatments can reduce inflammation so that the joints don’t become damaged. This can help prevent stiffness, pain and loss of mobility.
Medications for PsA
Medications can help make living with PsA much more comfortable and help to improve function and mobility. Anti-inflammatory drugs such as NSAIDs and corticosteroids are groups of medications that can reduce inflammation, pain and stiffness. Other medications called analgesics can help reduce pain. DMARDs are medications that can help reduce inflammation and prevent damage to joints. Biologics are the most advanced and targeted medications for PsA available so far. Biologics are considered a major breakthrough in the treatment of PsA because they improve the inflammation in both the joints and the skin. For some people with PsA, a combination of medications is needed to control the disease.
For more information about specific medications used to treat PsA, refer to the “pictopamphlets” in the Medications Section of this website.
Non-Steroidal Anti-Inflammatory Drugs or NSAIDs are medications that reduce the inflammation of joints caused by PsA. They also help to reduce symptoms such as pain. Luckily there are about 20 different anti-inflammatory medications available. So if one doesn’t work for you, try another.
Medications like prednisone can help control inflammation in some people. It can also help control symptoms of pain and stiffness. It is usually used in high doses for short periods of time. When used for long periods of time, prednisone can have side effects. You should to discuss the risks and benefits of using prednisone with your rheumatologist. Some patients also benefit from cortisone injections directly into a joint. This should be discussed with your rheumatologist.
Analgesic medications only control pain. They do nothing to control the disease or to prevent further joint damage. Analgesics can range from simple things like acetaminophen (Tylenol) to more potent narcotics like morphine.
The Disease Modifying Anti-Rheumatic Drugs (DMARDs) were initially used to treat rheumatoid arthritis. They are also effective in people with PsA. Methotrexate is the most commonly used DMARD in people with PsA. Methotrexate offers “two for one” treatment of PsA because it works well to treat the arthritis and the psoriasis of PsA. Other types of DMARDs work well for treating the arthritis of PsA, but are not as helpful for the skin. Other DMARDs that are used include: Sulfasalazine, Leflunomide (Arava), Gold (Myochrisine), and Hydroxychloroquine (Plaquenil). A newer medication working well to treat psoriatic arthritis is Apremilast (Otezla).
Until about a decade ago, there were few other options for people with PsA if anti-inflammatory medications and DMARDs weren’t enough to control their disease. That’s not the case today – people with PsA whose joint pain and stiffness aren’t relieved by anti-inflammatory drugs or DMARDs can turn to a group of medications called anti-TNF biologics.
Anti-TNF biologics are extremely effective and can make a big difference for people with PsA. Not only do they help the arthritis but they can also help the psoriasis. There are now 5 anti-TNF biologics available including Humira, Remicade, Enbrel, Cimzia, and Simponi. With 5 different anti-TNF biologics to choose from, if one doesn’t work, your rheumatologist may suggest another.
Skin Care for PsA
Skin care is also an important part of your overall treatment plan. If your psoriasis is severe, it can be helpful to consult a dermatologist. Some of the medications used to treat the arthritis of PsA are also helpful for psoriasis. See the Medications section for more information about medications for the treatment of psoriasis and PsA.
Psoriasis can also be improved with certain creams and lotions. “Topical” therapy is often used together with other medications that control the inflammation of the joints affected by PsA.
Many people with psoriasis can also benefit from moderate exposure to sunlight. Like for people without psoriasis, too much sunlight can cause skin damage. It is important to take steps to avoid sunburn.
Exercises for PsA
Physical therapy is an important part of your overall treatment plan. The right stretching and exercises can actually improve the stiffness in your joints. Physical activity can also reduce pain, fatigue and the emotional distress of PsA. Daily stretching and the right kinds of exercises can help keep the joints moving properly. It can also protect the joints by strengthening the muscles around them.
Learning how to protect your joints and how to use your joints properly can make a big difference. This can help ease the pain of PsA and avoid extra stress that can damage the joints. If the joints in your hands are affected by PsA, avoid carrying heavy bags by narrow handles or straps – use a cart to carry heavy items instead. Squatting or kneeling can place extra stress on the joints of your hips or knees. A trained arthritis physiotherapist can help design an exercise program tailored to you and your needs. They can also help teach you how to protect your joints and use them properly.
Below are some useful articles on exercising with arthritis:
- Exercise and Arthritis: An article by arthritis physiotherapist, Marlene Thompson
- Exercising in a Flare: Another excellent article written by Marlene Thompson on how to cope with flares through your exercise routine.
Natural or Home Remedies for PsA
There are no known natural remedies or complementary therapies that have been proven to help PsA in any significant way. However, it’s important to check with your rheumatologist to make sure that nothing interacts with your medication if you choose to use natural remedies or complementary therapies.
Surgery for PsA
In the most severe cases of PsA the joints may be so badly damaged that they need to be replaced. Surgery usually involves replacing a damaged joint with an artificial joint, most commonly the knee or hip. Surgery can help people with severe, advanced PsA by reducing pain, improving their mobility and restoring their functioning. More rarely, the joints of the shoulder, elbow or ankle can be replaced by surgery.
Diet for PsA
Questions about diet and arthritis are very common. We all want to know what we can do to help ourselves. Can we change our diet to improve our immune system and help our arthritis? Changing our diet gives us a sense of control over a disease which often seems to have a mind of its own.
Unfortunately, there is no diet that has been proven to significantly alter the course of PsA or other types of arthritis or psoriasis. Following the basics of healthy eating can help improve health and well-being in everyone, including those with PsA. Keeping a healthy weight can help reduce the load on your weight-bearing joints including the spine, knees and hips.
Alcohol and PsA
Many of us like to share a glass of wine, a beer, or a spirit from time to time. Unfortunately, due to the nature of PsA, some people may turn to alcohol to help cope with the pain and distress. Furthermore, people with psoriasis, including PsA, tend to be heavier and have fattier livers. This can cause problems when treating psoriasis or PsA with certain medications.
The bottom line is that alcoholic beverages are not an effective treatment for PsA. Besides, there are so many effective treatments available for PsA, you don’t need to try to manage your illness with alcohol.
Smoking and PsA
Cigarette smoking, whether you have PsA or not, has no positive effects on any aspect of your health. Smoking can be especially harmful to people with PsA whose upper spine or whose tendons in the ribcage are affected by the disease. That’s because when the joints or tendons in the chest are inflamed, it’s harder to breathe in deeply. Smoking is also another risk factor for heart disease, like PsA itself.
If you are a smoker with PsA, you have at least two risk factors that increase your chances of developing heart disease. Quitting could be one of the best things you can do to improve your overall health.