Early treatment is important in psoriatic arthritis. The earlier the treatment, the more likely you can prevent serious damage down the road. The specific treatment will depend on: how severe your psoriatic arthritis is, the type of psoriatic arthritis you have, and if you have damage already.
Usually the first line of medications are anti-inflammatory medications. These would be for people without damage and with a mild disease. You should be monitored about 4 times a year to make sure your symptoms do not increase. You will get a skin exam and joint, tendon and spine check at each visit. Should there be any worsening of your disease, a change in medication will be necessary. Anti- inflammatory medication may not be enough.
If control over the psoriatic arthritis has not been achieved, if the symptoms are not gone, and if there’s persistent joint inflammation, then you may be moved to a disease-modifying drug. These drugs take the pain, swelling, and skin symptoms away by working on the immune system. By working through the immune system, we can hopefully prevent damage in the joints, in the tendons, in the spine, or wherever the psoriatic arthritis shows in that person. Again, about every three months, we reassess. And if we are not at the goal of little to no symptoms, we change the treatment by adding another medication or changing the dose of current medications.
Severe Disease with damage
If there has already been damage to the joints, the treatment may be more aggressive. A combination of disease-modifying drugs may be used at this point. Joint damage cannot be reversed, so we do all we can to prevent additional damage.
Rheumatologists often refer people with psoriatic arthritis to physical therapy (PT). We know will allow the spine to retain the range of motion, to prevent a return of symptoms, and to strengthen the muscles that stabilize the spine. PT is also important for tendons that have been affected, to strengthen the muscles and joints, and to increase the overall stability. PT is used after inflammation is controlled. There is a risk of rupturing tendons if they are too inflamed. Other interventions that people can do and will help treatment.
One of the most important things is in people who are overweight or obese is weight loss. Losing 10% of the body weight in people who are overweight or obese is like adding a new treatment. Weight loss increases response to medications.
Topical treatments are frequently prescribed for the treatment of psoriasis. Patients are sometimes not excited about them because it can be inconvenient and time consuming to apply creams, and keep them on the skin. Creams, especially those that contain steroids, have different strengths. If a doctor prescribed a certain cream for lesions on the legs, for example, it’s not okay to use that on the face, or some other lesion that developed because by having different strengths they can have many more side effects on thin skin. It is important to have a dermatologist involved in the care of a patient with a lot of psoriasis so that we can assure the right treatment is being used for the skin.
There are a number of ways to treat psoriatic arthritis depending on the person. People with psoriatic arthritis can expect to have frequent monitoring of their disease and treatment. As we continue treatment, our goal is for patients to experience long-term remission. When and if long-term remission is experienced, and there’s no damage in the background, then there can be a conversation about decreasing treatment. But that usually happens after people have been controlled for a long time. And it has to be done carefully, because there’s always the potential for a relapse.