Psoriatic Arthritis Treatment
by Beth G. Hodges, MD

The best psoriatic arthritis treatment for anyone with psoriatic arthritis will depend on the subtype of the arthritis, the severity of symptoms, and the overall health of the patient. Each patient must have his or her own tailored treatment plan.

Medications that Reduce Inflammation

The mainstay and starting point of most treatment plans is Non-Steroidal Anti-Inflammatory Drugs, or "NSAIDS." In addition to helping to relieve pain, they also help to reduce swelling, redness, and stiffness (or in other words, stop inflammation.)

This class of medication includes ibuprofen, naprosyn, celecoxib (Celebrex), meloxicam (Mobic), etodoloac (Lodine), and many others. They range from cheap to fairly expensive, have a quick onset of symptom relief, and can sometimes be combined with other treatments.

The biggest danger with this class of medications is usually a risk of stomach ulceration, so it is often advised that older patients use them in conjunction with some type of medication to protect the lining of the stomach (i.e. proton pump inhibitors or histamine receptor blockers.)

People with heart conditions, kidney disease, or liver problems also need to use these agents with caution and only under the direction of a physician. Blood work can be done to monitor for harmful effects from these medications.

Medications to Supress the Immune System

Since psoriasis and psoriatic arthritis occur from the body's immune system causing an excessive turnover of skin cells (ie the rash) and attacking joints within the body (the arthritis), it makes sense that medications that suppress the immune system can be used to suppress this disease.

One such medication is methotrexate. Methotrexate was actually developed as a form of chemotherapy for cancer originally, but is now used to control a number of autoimmune disorders. It can be a wonderful agent if used carefully and with appropriate monitoring. It is usually dosed as a pill once weekly.

People taking methotrexate should ALWAYS take a daily 1mg folic acid supplement, as this drug can deplete the body's supply of folic acid. Also, monthly blood work monitoring the white blood cell count, the red blood cell count, and the liver enzymes must be done as long as a person remains on the drug.

Patients on this medication also need to be aware that methotrexate can damage the liver over time. Sometimes a procedure called a liver biopsy is done to look for hidden liver damage to a patient who has been on the medication for several years.

Methotrexate should be stopped temporarily in event of an infection, and these patients need to understand that Methotrexate lowers their immune systems ability to fight diseases. So it is important for them to take annual flu shots, use caution when around serious contagious diseases, and report any episodes of fever to a physician. They should not take live virus vaccines, as these can cause illness. Dead virus vaccines are recommended.

Disease Modifying Medications

In psoriasis and psoriatic arthritis there are increased levels of a substance called tumor necrosis factor (TNF). Agents that lower levels of TNF (called DMARDS -- Disease Modifying Anti-Rheumatic Drugs) can be very effective for treating these conditions. Names of some of these agents, given as injections, are Enbrel, Remicade, Humira. Like methotrexate, these agents lower the immune system, so precautions to prevent infections must be followed. These DMARDS are extremely expensive.

Steroids

Prednisone is another agent that lowers the immune system response and can also decrease inflammation. Like nonsteroidals (nsaids), it can increase the risk of ulceration of the stomach and must be used cautiously. Prednisone also weakens bone strength and over time can place a person at risk for osteoporosis and/or osteoporotic bone fractures. Annual or bi-annual bone densitometry should be done to monitor for osteoporosis.

Other Psoriatic Arthritis Treatments

Zinc and Vitamin A have shown some modest success with control of psoriatic arthritis, so it is recommended that patients with this condition consume high quantities of fruits and vegetables.

Glucosamine and chondroitin have been shown separately and together to have some benefit in relieving arthritis pain and stiffness and can for some be useful adjunctive therapies, though they have to be taken daily for several months to show benefit. Fish oil, or omega-3 supplements show a similar success rate and can also be heart healthy.

Increased weight is synonymous with increased stress on the joints, so it is advised that those with psoriatic arthritis try to maintain a healthy weight. On a similar note, regular exercise strengthens muscles, and strong muscles mean less stress on joints.

Treatments for psoriatic arthritis vary in cost and intensity because the disease itself varies from person to person. Each sufferers treatment plan should be individually designed by the physician and patient working together.

Published - October, 2009