Psoriatic Arthritis Treatment Overview

When to see a healthcare provider

Always see a healthcare provider if you have symptoms of psoriatic arthritis, like a red or white scaly rash and swelling, pain, and stiffness of the joints. If not treated, the joints can become severely damaged. Get urgent treatment if your joints become severely swollen and stiff.

Getting diagnosed

• There is no single test that can definitively diagnose psoriatic arthritis. A primary care provider or rheumatologist (doctor specializing in inflammatory conditions) will diagnose you based on your symptoms, physical exam, and possibly blood tests and imaging tests.
• Imaging tests, such as X-rays or an MRI, and blood tests may be ordered to help rule out other causes of joint pain, such as gout or rheumatoid arthritis.

What to expect from your doctor visit

• If OTC NSAIDs haven’t helped, your doctor may prescribe different NSAIDs like celecoxib (Celebrex) or meloxicam (Mobic).
• Cortisone injections: Cortisone is a type of injectable anti-inflammatory that acts within the joint. These injections are typically given by a rheumatologist or orthopedic surgeon directly into the joint and offer short-term relief from flares up.
• Disease-modifying antirheumatic drugs (DMARDs) treat psoriatic arthritis by reducing the damage in the joints. Common DMARDs include methotrexate (Trexall) and sulfasalazine (Azulfidine).
• Biologic agents decrease arthritis pain, eliminate skin lesions, and limit the immune system’s ability to damage joints. They are for people with more severe psoriatic arthritis. There are several types of biologics, including TNF inhibitors, interleukin 17 inhibitors, interleukin 12/23 inhibitors, and JAK inhibitors.
• Immunosuppressants target the immune system to reduce joint damage. Common immunosuppressants include azathioprine (Imuran) and cyclosporine.
• If damage becomes severe, you may need surgery to replace joints. Damaged cartilage and bone is removed and replaced with metal and plastic parts.

Prescription medications for psoriatic arthritis

• Prescription NSAIDs: celecoxib (Celebrex), meloxicam (Mobic), nabumetone (Relafen)
• DMARDs: methotrexate (Trexall), sulfasalazine (Azulfidine)
• TNF inhibitors: adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade)
• Interleukin 17 inhibitors: secukinumab (Cosentyx), guselkumab (Tremfya), ixekizumab (Taltz)
• Interleukin 12/23 inhibitors: risankizumab (Skyrizi), ustekinumab (Stelara)
• JAK inhibitors: tofacitinib (Xeljanz), upadacitinib (Rinvoq)
• Immunosuppressants: azathioprine (Imuran), cyclosporine

Types of psoriatic arthritis providers

• A primary care provider may diagnose psoriatic arthritis and may be able to help manage it.
• A rheumatologist (doctor specializing in inflammatory conditions) can diagnose the condition and treat more complex cases. They can also give injections to treat the inflammation that attacks the joint.
• You may also see a dermatologist, who can treat psoriatic arthritis symptoms that affect the skin.

Tips for treating psoriatic arthritis

• If you have mild symptoms, OTC anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve) may help control pain and inflammation.
• Low-impact exercise, like biking and walking, helps relieve pain and stiffness without putting too much stress on your joints.
• Do not smoke. Smoking can speed up the progression of psoriatic arthritis and interfere with treatment.
• Use heat or cold. A warm bath can help treat sore joints, while applying ice packs to the joints relieves swelling. Alternate the two or use whichever one you find most effective.

Psoriatic arthritis cannot be prevented, but making lifestyle changes can help your symptoms.

• Lose weight if necessary. Extra pounds increase inflammation and put more stress on your joints.
• Try acupuncture, which may help reduce joint pain.
• Eat inflammation-fighting foods, like fatty fish (salmon, tuna), olive oil, and nuts.
• Limit foods that can worsen inflammation, like red meat and processed foods that are high in sugar, trans fats, or saturated fat.
• Do low-impact exercise, which can help keep joints and muscles strong and reduce your pain.