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