These Psoriatic Arthritis Treatments May Help Prevent Joint Damage
Reducing pain is just one way treatment can help.

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.
If you’ve been diagnosed with PsA, there are a variety of effective treatment options that can do more than treat the symptoms of psoriatic arthritis. Here are the options available to treat PsA:
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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.
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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.
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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.
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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.
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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.
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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.
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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.”
Dr. Alon is a board-certified rheumatologist in New York City.
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How we treat psoriatic arthritis
depends on what kind of pain and
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symptoms patients have.
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[MUSIC]
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Psoriatic arthritis is an autoimmune
disease, which means your body's
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immune system attacks healthy tissue,
such as the joints and the skin.
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How we treat psoriatic arthritis
depends on what kind of pain and
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symptoms patients have.
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Treatment can improve pain and stiffness
of the arthritis, and prevent joint damage
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from occurring, and skin redness,
and scaliness from psoriasis.
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People with mild psoriatic
arthritis symptoms can take
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nonsteroidal anti-inflammatory drugs.
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Such as, ibuprofen, and
naproxen, initially.
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But they won't prevent joint
damage from occurring.
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And even though these drugs can be
over the counter, they do have risks.
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These include an increased
risk of heart attack and
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stroke, stomach irritation,
bleeding, and liver damage.
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For modern to severe cases of psoriatic
arthritis, we use a class of medications
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called, Disease Modifying
Anti-Rheumatic Drugs, or DMARDs.
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These suppress chemicals in
cells that cause inflammation.
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This prevents joint damage and
the progression of disease.
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Most of these drugs you take orally,
the one we often prescribe for
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psoriatic arthritis is methotrexate.
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Because the suppress the immune system,
they can have serious side effects.
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It's important to review
the risks with your doctor.
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Methotrexate, for example,
can cause liver toxicity,
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lung disease, and bone marrow suppression.
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The newest class of treatment for
psoriatic arthritis is a type of [UKNOWN],
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called biologics.
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These are often effective in patients
on responding to basic DMARDs, and for
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patients who have lower back
pain as part of their symptoms.
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Instead of suppressing the whole immune
system, these targeted drugs blocks
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specific parts of the immune system,
the drive inflammation.
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They usually given by injection or
infusion, those some come and perform.
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One class of biologics is anti
[INAUDIBLE], TNF-alpha drugs,
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such as etanercept, adalimumab,
golimumab, infliximab, and certolizumab.
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People with psoriatic arthritis have
excess production of TNF-alpha in the skin
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or joints, and blocking TNF-alpha
helps stop the inflammatory cycle.
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These drugs can cause skin reactions
near the injection site, and
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can increase your risk of getting
infections like, tuberculosis.
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They're not recommended for people with
multiple sclerosis, heart failure, or
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a history of cancer.
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As rheumatologist, our job is to come up
with a unique treatment plan for each
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patient that addresses symptoms, minimize
side effect, and fits their lifestyle.
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We have so many options right now for
treating psoriatic arthritis.
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The sooner you find a treatment
regimen that works for you,
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the sooner you'll feel better, and
more chances for long term joint damage.
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Psoriatic arthritis treatment. Atlanta, GA: Arthritis Foundation. (Accessed on May 1, 2021 at https://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/treatment.php.)
Treating psoriatic arthritis. Alexandria, VA: National Psoriasis Foundation. (Accessed on May 1, 2021 at https://www.psoriasis.org/psoriatic-arthritis/treatments.)
Treatment of psoriatic arthritis. Waltham, MA: UpToDate, 2020. (Accessed on May 1, 2021 at https://www.uptodate.com/contents/treatment-of-psoriatic-arthritis.)