So you’ve been diagnosed. But what are the treatments for psoriatic arthritis? Is there anything that can be done??
Yes! As I mentioned in Part 1 of this series, the great thing about the meds we Rheumys use is that they can treat and help resolve not only the psoriatic rash but may actually help you have less arthritic pain if you happen to have inflammatory arthritis known as PsA (Psoriatic Arthritis). So, if you are tired of phototherapy or topicals that keep you flaring, perhaps you should consider the following treatments for psoriatic arthritis.
The ‘older’ Rheum meds that can help clear the psoriatic rash, with or without arthritis, include:
Sulfasalazine (aka SZS) The good and bad of SZS:
- lots of pills every day and they aren’t small by any means
- it’s sulfa, so potential issues include: nausea, diarrhea, sun sensitivity, rash, headache, change in color of urine, or need to watch blood work (blood count)
Methotrexate (aka MTX) The good and bad of MTX:
- only taken once a week
- need folic acid daily
- can affect liver and blood count, so need labs every 2-3 months
- can cause nausea, fatigue, mouth sores, hair loss, or weight loss
Biologic medications block very specific ‘biological’ pathways of inflammation. These pathways are typically caused by the activation of specific cytokines (sigh – tow – kines). You can think of cytokines as hormones for the immune system. Two of the most important cytokines that create inflammation in our bodies if we have psoriasis or psoriatic arthritis include TNF and Interleukin (enter – lou- kin).
- Biologics that block TNF that can be used to treat Psoriasis or PsA: Humira, Enbrel, Remicade, Cimzia, Simponi
- Biologic that block Interleukin that can be used to treat Psoriasis or PsA:Stelara, Cosentyx, Taltz
- Biologic that block T cells that can be used to treat Psoriatic Arhritis: Orencia
The major issue with these ‘Biologics’ is infection (typically skin, sinus, and lung infections). Also, we sometimes see weird infections (like fungal infections) in people with a compromised immune system. The overall risk of infection is about 3-5% and 3 times the risk in comparison with meds like Sulfasalazine and Methotrexate. That being said, they can and do REALLY help resolve the rash and joint pain.
A bit about Prednisone and Psoriasis:
Prednisone can help the joint pain, swelling, and stiffness associated with Psoriatic arthritis and can clear the rash of Psoriasis. However, due to the potential adverse effects of prednisone, most providers opt for anti-inflammatories over prednisone for long-term use. In addition, though Psoriasis (the rash) will clear with the use of prednisone, it WILL flare (and often worse than it was) as the prednisone is tapered off.
Common Supplements For Psoriasis / Psoriatic Arthritis
- Fish Oil
- Vitamin D
- Milk Thistle
Essential oils are becoming more and more popular as well. Those that have shown “anti-inflammatory” properties include:
- Tea Tree
- Oregon Grape
- Avocado /B12-Aloe
Supplements, oils, and naturopathic treatments are still ‘medications’ and as a result can have adverse effects and interact with other treatments. Therefore, it is important to discuss the use of these as well with your health care providers.
Remember, one treatment doesn’t work for everyone. I would encourage you to be open to ALL the options . . . dietary modification, supplements, and yes, even traditional medications.
After all, this is you, your skin, and your joints we are talking about.
And you’re worth it! You’re worth living your value one choice at a time.