Psoriatic Arthritis Treatment, Nail Disease, and Natural Remedies

Question

HI, I HAVE HAD SEVERE PSORIATIC ARTHRITIS FOR THE PAST 6 YEARS. IT HAS CAUSED ME TO LOSE MY TOE AND FINGER NAILS AND SEVERE JOINT DETERIORATION. I WAS ON METHOTREXATE FOR A LONG PERIOD WITH NO SUCCESS AND THEN ON TO ARAVA COMBINED WITH STERIODS AND ANTI INFLAMATORIES. 12 MONTHS AGO I WENT OFF ALL DRUGS AS THEY WERE NOT PUTTING MY ARTHRITIS INTO REMISSION. MY PAIN LEVELS ARE CHRONIC AND I WOULD LIKE TO FIND NATURAL THERAPIES TO TRY AND PUT MY ARTHRITIS INTO REMISSION. I AM DESPERATE.

Answer

There is now an extensive literature and clinical experience to show that psoriatic arthritis may be responsive to many different medications.  Many physicians will start with methotrexate as used for rheumatoid arthritis, once weekly with folic acid.  This may improve both joints and skin disease.  Another option that has been shown to have some efficacy on the joints (but not the skin) is sulfasalazine.   There is also a study to show that Arava (leflunomide) has some efficacy in psoriatic arthritis.  It sounds like your case though has not been responsive to methotrexate or leflunomide.  One option that has not been tried is the group of agents known as TNF inhibitors.  These include Enbrel (etanercept), Humira (adalimumab), and Remicade (infliximab).  These are all active on both the skin and the joints and may slow joint deterioration.  Some have also reported improvement in the nail disease with this class of agents as well.  All of the medications that I have discussed have significant clinical data to support their effectiveness.  While I know that many patients would like something “natural” to control their disease, it is important to recognize that psoriatic arthrirtis like rheumatoid arthritis is an autoimmune disease with the potential to significantly damage joints and cause disability.  While many patients advocate for “natural” remedies, the data to support their effectiveness is lacking, and they have never been tested in comparison to what is considered our gold standard.  I would thus recommend you discussion with your rheumatologist other medical options that have not been tried for your condition (TNF antagonists) yet to prevent further damage, and then to discuss the use of supplements, etc as ADJUNCTS rather than primary therapy.

Clifton Bingham, III, MD

About Clifton Bingham, III, MD

Associate Professor of Medicine
Director - Johns Hopkins Arthritis Center