Treatment for psoriatic arthritis, or PsA, goes far beyond reducing joint pain. In fact, thinking solely about treating PsA joint pain may mean you’re missing a crucial part of the puzzle: preventing permanent joint damage caused by the immune system.
PsA is an autoimmune disease that causes the immune system to mistakenly attack the skin and joints. Because of this, the goals of treating PsA are to not only reduce joint pain, but also to reduce swelling, prevent joint damage, keep inflammation levels low, treat skin complications from psoriasis, and prevent the progression of the disease.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)—such as ibuprofen and naproxen, which are available over the counter (OTC)—can help reduce joint pain for people with mild psoriatic arthritis symptoms, according to Leah Alon, MD, rheumatologist at Harlem Health Center and Queens Health Center in New York City. Unfortunately, OTC pain relievers do not prevent joint damage, and they still come with side effects: An increased risk of heart attack and stroke, stomach irritation, bleeding, and liver damage, according to Dr. Alon.
Disease-Modifying Antirheumatic Drugs (DMARDs) are a class of medications that suppress the chemicals in the cells that cause inflammation. “This [suppression] prevents joint damage and the progression of the disease,” says Dr. Alon. Because DMARDs suppress the immune system, they can cause side effects such as liver toxicity, lung disease, and bone marrow suppression.
Biologics are a newer type of DMARDs that are used when patients aren’t responding to basic DMARDs. They are also effective for people with PsA who experience lower back pain. “Instead of suppressing the whole immune system, these targeted drugs block specific parts of the immune system that drive inflammation,” says Dr. Alon. These are available in injection, infusion, and pill form.
Anti-Tumor Necrosis Factor-Alpha (TNF-alpha) drugs are a type of biologic. This medication blocks a protein called TNF-alpha that causes inflammation. Psoriatic arthritis is associated with excess production of this protein in the skin and joints, so blocking the TNF-alpha protein can break the inflammatory cycle. Side effects include skin reaction near the injection site and an increased risk of infections like tuberculosis.
IL-Inhibitors are a type of biologic that blocks interleukins, another inflammatory protein in the immune system. They’re typically used when TNF-alpha drugs have been ineffective. IL-inhibitors come in injection form and might increase the risk of infections and certain cancers.
Abatacept is a drug typically used to treat rheumatoid arthritis, but has recently received FDA approval for treating PsA. This medication disrupts the activation of T cells, the white blood cells that attack “invaders” in the body and cause inflammation.
Apremilast is a pill that targets an enzyme called PDE4 in order to reduce inflammation. It can result in GI symptoms such as diarrhea, nausea, vomiting, and unintended weight loss.
“As rheumatologists, our job is to come up with a unique treatment plan for each patient that addresses symptoms, minimizes side effects, and fits their lifestyle,” says Dr. Alon. “The sooner you find a treatment regimen that works for you, the sooner you’ll feel better and lower your chances of long-term joint damage.”