|
|
|
Treatments
for Psoriatic Arthritis
In
general, the treatments for psoriatic arthritis are the same as for
other sorts of arthritis and can be divided into first-line and second-line
as with treatment of the skin. The first-line treatments can be started
by your GP without the need for specialist advice. In the early stages,
it does not matter very much if the diagnosis is not confirmed, because
the treatment will be the same for any person with joint pains.
•
Physiotherapy is often forgotten or used only at later stages
of the disease, but can be very useful both to treat pain and stiffness
and to educate you about exercises, correct lifting techniques and other
simple things that can help prevent further problems.
• Non-steroidal anti-inflammatory drugs (NSAIDs)
are a class of drugs that were derived from aspirin, and they have a
wide range of uses. In arthritis, NSAIDs are used early to relieve pain
by working against the inflammation, so they also relieve swelling and
stiffness. There are many different brands and strengths, starting with
ibuprofen – which is probably the best known, as it was the first
one to be made available without prescription, as Nurofen. They have
some side effects, of which the most important is irritation of the
stomach; this sometimes leads to ulceration, so you should not buy them
to use long term without discussing it with your GP. (They are also
available as creams and gels to rub directly into the skin over a joint
but this is an expensive way of using the drug with little definite
evidence that it works.)
• Steroid injections. Although steroid tablets
should be seen as a second-line treatment, injections directly into
a joint can be useful earlier if only one large joint, such as the knee,
is affected. Pain relief and getting mobility back can be very rapid,
and there is only a risk of the general side effects of steroids if
injections are given too often. This should not happen, because other
types of treatment would then be indicated. Many GPs are very good at
giving steroid injections and will happily do it but others might want
to refer you to a specialist if they don’t feel confident and
have not had much practice in this type of treatment.
• Methotrexate is also used for other types of
arthritis, so it fits in well if you have skin and joint psoriasis.
It is taken as a small weekly dose and needs careful monitoring. For
more information on Methotrexate please see our systemics
page.
• Steroids are powerful anti-inflammatory drugs,
so can have a dramatic effect in treating an acute flare-up of arthritis.
In some cases, they are also used long term in low doses to try to keep
a balance between the benefits and the potential side effects. If steroids
are used in high doses, careful monitoring of the skin psoriasis is
essential because rapid changes in steroid dose can cause problems,
with dramatic worsening of the skin sometimes to the point of pustular
psoriasis and erythroderma.
• Sulfasalazine (Salazopyrin) is being used increasingly
often in psoriatic arthritis. It is another type of anti-inflammatory
drug that was used mainly for inflammatory gut diseases such as ulcerative
colitis. People with ulcerative colitis can get a type of arthritis
affecting the lower back, and they noticed that this as well as their
gut problems improved when taking sulfasalazine. It was tried in other
forms of arthritis and does seem to work well in psoriatic cases. Some
rheumatologists now use it as a first-choice tablet treatment and then
add in methotrexate if needed.
• Immunosuppressive drugs such as azathioprine
and ciclosporin are sometimes used but seem less effective for the arthritis
than they can be for the skin.
• Gold injections are used less often than they
were in the past for all forms of arthritis. They were used only rarely
for psoriatic arthropathy, because one of the common side effects is
a skin rash! In a few patients they have worked well and so might be
considered if all else fails.
• Leflunomide is a tablet treatment that is used
mainly in rheumatoid arthritis but can be used in some other types of
arthritis. It is a DMARD (disease-modifying anti-rheumatic drug)
•
Biologcs
- Etanercept
(Enbrel), Infliximab (Remicade) and Adalimumab (Humira) all have their
license for use in Psoriatic Arthritis treatment. However there are
strict guidelines as to how they can be prescribed. For more information
on biological treatments please see our biologics
page.
For
more detailed information regarding the treatments for Psoriatic Arthritis,
please contact
us
|
|
If
this information has helped you, please help us by sending a donation |