Treating psoriatic arthritis

The main aims of treatment will be to relieve your symptoms, slow the progression of the condition and improve your quality of life.

For most people, this involves trying a number of different medications, some of which can also treat the psoriasis. Ideally, you should take one medication to treat both your psoriasis andpsoriatic arthritis whenever possible.

The main medications used to treatpsoriatic arthritis are summarised below and include:

• non-steroidal anti-inflammatory drugs (NSAIDs)
• corticosteroids
• disease-modifying anti-rheumatic drugs (DMARDs)
• biological therapies

Non-steroidal anti-inflammatory drugs (NSAIDs)

Your GP may first prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to see if they help relieve pain and reduce inflammation.

There are two types of NSAIDs and they work in slightly different ways:

• traditional NSAIDs, such as ibuprofen , naproxen ordiclofenac
• COX-2 inhibitors (often called coxibs), such as celecoxib or etoricoxib

Like all medications, NSAIDs can have side effects. Your doctor will take precautions to reduce the risk of these, such as prescribing the lowest dose necessary to control your symptoms for the shortest time possible.

If side effects do occur, they usually affect the stomach and intestines, and can include indigestion and stomach ulcers . A medication called a proton pump inhibitor (PPI)will often be prescribed alongside NSAIDs a PPI helps protect your stomach by reducing the amount of acid it produces.

This can offer rapid relief with minimal side effects, and the effect can last from a few weeks to several months.

Corticosteroids can also be taken as a tablet, or as an injection into the muscle, to help lots of joints. However, doctors are generally cautious about this because the medicationcancause significant sideeffects if usedin the long term, andpsoriasis can flare up when you stop using it.

Disease-modifying anti-rheumatic drugs (DMARDs)

Disease-modifying anti-rheumatic drugs (DMARDs) are medications that work by tackling the underlying causes of the inflammation in your joints.

They can help to ease your symptoms and slow the progression of psoriatic arthritis. The earlier you start taking a DMARD, the more effective it will be.

Leflunomide is often the first drug given for psoriatic arthritis, although sulfasalazine ormethotrexate may be considered as alternatives.

It can take several weeks or months to notice a DMARD working, so it's important to keep taking the medication, even if it doesn't seem to be working at first.

Biological treatments

Biological treatments are a newer form of treatment for psoriatic arthritis. You may be offered one ofthese treatments if:

• your psoriatic arthritis hasn't responded to at least two different types of DMARD
• you're not able to be treated with at least two different types of DMARD

Biological drugs work by stopping particular chemicals in the blood from activating your immune system to attack the lining of your joints.

Some of the biological medicines you may be offered include:

• adalimumab
• apremilast
• certolizumab
• etanercep
• golimumab
• infliximab
• secukinumab
• ustekinumab

See our page on treating psoriasis for more information about these medications.

The most common side effect of biological treatments is a reaction in the area of skin where the medication is injected, such as redness, swelling or pain, although these reactions aren't usually serious.

However, biological treatments can sometimes cause other side effects, including problems with your liver, kidneys or blood count, so you'll usually need to have regular blood or urine tests to check for these.

Biological treatments can also make you more likely to develop infections. Tell your doctor as soon as possible if you develop symptoms of an infection, such as:

• a sore throat
• a high temperature (fever)
• diarrhoea

Biological medication will usually be recommended for three months at first, to see if it helps. If it's effective, the medication can be continued. Otherwise, your doctor may suggest stopping the medication or swapping to an alternative biological treatment.

Complementary therapies

There's not enough scientific evidence to say that complementary therapies, such as balneotherapy (bathing in water containing minerals), works in treating psoriatic arthritis.

There's also not enough evidence to support taking any kind of food supplement as treatment.

Complementary therapies can sometimes react with other treatments, so talk to your GP, specialist or pharmacist if you're thinking of using any.