Treatment of PsA is variable, depending on the clinical manifestation. There is no consensus on specific treatment of PsA, but the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has published recently guidelines for the treatment of the different manifestations of PsA based on literature review and expert consensus.
For mild peripheral arthritis, non-steroidal anti-inflammatory drugs (NSAIDs) and/or intra-articular corticosteroids may be used. Injections of joints covered by psoriatic plaques should be performed with caution due to the abundance of bacteria usually discovered on the skin lesions.
For moderate-to-severe disease, disease-modifying antirheumatic drugs (DMARDs) and/or TNF inhibitors should be considered.
The following DMARDs may be used:
- Methotrexate is effective for both the cutaneous and peripheral articular manifestations of psoriasis. It is generally the DMARD of first choice, given its efficacy, safety, and tolerability profile.
- Leflunomide is effective for both the cutaneous and peripheral arthritis of psoriasis. Like methotrexate, it has potential liver toxicity and patients need to have liver enzymes monitored periodically.
- Sulfasalazine may benefit the peripheral arthritis, but has no significant impact upon the activity of cutaneous disease.
- Cyclosporin Amay be effective for both cutaneous and articular disease, but caution must be exercised given that as many as 21% of patients may develop hypertension and 17% nephrotoxicity.
- Etanercept®, Remicade®, and Humira®, all tumor necrosis factor (TNF) inhibitors, have been found to be effective and well tolerated in the treatment of both psoriasis and psoriatic arthritis.
Intra-articular and low-dose systemic corticosteroids may be used as bridging therapy while treatment with a DMARD is instituted, but tapering of high-dose corticosteroids has been associated with the development of generalized pustular psoriasis.
Physical and occupational therapy are often critical to the development of interventions to both protect the involved joints and maintain function.
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*Images within this article are from the American College of Rheumatology Slide Collection.