Psoriatic arthritis—exploring your drug options

Stiff and achy joints are not among life's pleasantries. Add to that itchy, scaly skin that's discolored and swollen and you're dealing with a double-trouble disease: psoriatic arthritis. Up to 2.4 million people in the United States have this often-debilitating autoimmune disease, according to the National Psoriasis Foundation. It usually develops in people between the ages of 30 and 50, can affect nearly any part of the body, and often shows up in the form of flare-ups that can happen at any time.

Psoriatic arthritis can be as painful as it is frustrating to treat. Arthritis already hurts. But when the symptoms are complicated by psoriasis, the impact on your health and quality of life is even greater. That’s why it’s important to put a treatment plan in place—to help relieve both skin and joint symptoms. Some treatments address both. Certain medications can help you reduce inflammation in your body, slow joint damage, ease pain, and minimize skin flare-ups.

A range of medications for psoriatic arthritis

While there's no cure for either arthritis or psoriasis, have a conversation with your healthcare provider (HCP) or specialist (usually a rheumatologist) to see if drug therapy can help you cope better with this disease. Depending on the severity of symptoms, psoriatic arthritis is usually treated with the following medications:

• Over-the-counter pain relievers such as aspirin, acetaminophen, ibuprofen, or naproxen
• Prescription corticosteroids that provide short-term relief from pain and swelling
• Prescription disease-modifying antirheumatic drugs (DMARDs) that help relieve symptoms and slow joint damage

If pain relievers and corticosteroids don't offer enough relief from psoriatic arthritis, your HCP may recommend DMARDs. DMARDs can help block your body's immune system from attacking healthy cells in your skin and joints and may be taken alone or with pain relievers and corticosteroids.

There are two types of DMARDs: nonbiologic and biologic. Nonbiologic DMARDs affect the immune system as a whole and are typically prescribed in pill form. Biologic DMARDs, on the other hand, are designed to target specific immune cells and are given as injections or through an intravenous (IV) infusion. Biologic DMARDs are often prescribed when regular DMARDs don't do the trick.

Most FDA-approved biologic DMARDs are convenient for people to use at home, and they tend to work more quickly than nonbiologic DMARDs, says Scott Zashin, MD, a rheumatologist in Dallas. "They may also have a better chance of preventing disease progression," Zashin says.

Are DMARDs right for you?

DMARDs—both biologic and nonbiologic—can help relieve pain and reduce joint damage for people with psoriatic arthritis, but like all medications, they have risks. Talk to your HCP about possible side effects, which can range from mild to serious.

"These medications act by suppressing some aspect of the immune system in order to control the unwanted inflammatory response,” explains Howard Blumstein, MD, a rheumatologist in Smithtown, New York. People who take them are at higher risk of infection and should be monitored closely by an HCP. Still, says Blumstein, "for most people, the downsides are outweighed by the good—especially the opportunity to halt the progression of their illness and not be crippled by it."

Before you make up your mind on any one treatment option, it's a good idea to have an honest conversation with your HCP.