Psoriatic Arthritis Treatment
Treatment for psoriatic arthritis is suppressive instead of curative. In patients with psoriatic arthritis that is very aggressive and potentially destructive, DMARDs or Disease Modifying Anti-Rheumatic Drugs should be used early in the course of the disease. The following list of DMARDs below should be taken in consideration. Exercise programs at home should also be done. It is also best to consult a physical therapist which can customize exercise programs depending on the severity of the disease and the physical capability of the patient. Application of hot compress is also very helpful in relaxing the muscles before doing any exercise. The main purpose of exercise for arthritis is to strengthen, maintain and improve the range of motion of the joints.
Medications for Psoriatic Arthritis:
Methotrexate – It is effective on cutaneous and peripheral articular effects of psoriases. Methotrexate is the first choice of DMARD because of its efficacy and tolerance profile. Anti-malarial drugs, retinoic acid and its derivatives may also help in psoriatic arthritis treatment.
Sulfasalazine – it has great benefit on the peripheral joints but does not help very much on the activity of cutaneous diseases. Sulfasalazine blocks the inflammatory response and gives fewer side effects.
Cyclosporin A – it is effective for both cutaneouse and articular disease but care must be taken because as many as 21% of patients taking this medication may develop hypertension and 17% may have nephrotoxicity. Cyclosporin can be used to taper down severe inflammation quickly.
Etanercept®, Remicade®, and Humira®, Tumor necrosis factor (TNF) inhibitors – these drugs have been found to well tolerated and also effective in treating psoriasis and psoriatic arthritis. Etanercept (Enbrel) inhibitis TNF, the cytokine that contributes to inflammation.
Prednisolone ( Corticosteroid ) – corticosteroids can be injected into the joints fro treating severe cases of psoriatic arthritis.
Nonsteroidal anti-inflammatory drugs – Ibuprofen (Motrin, Ibuprin, Advil, Excedrin IB) – NSAIDs decrease inflammation and pain by reducing the synthesis of prostaglandins. It is best to take this with food because it reduces the chances of stomach irritation.
5-Aminosalicylic acid derivatives – Sulfasalazine (Azulfidine, EN-Tabs) – these medications also inhibit the synthesis of prostaglandin resulting into the reduction of inflammation and pain.
Mease PJ: Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomized trial. Lancet 356:385, 2000.
Mease PJ: Cytokine blockers in psoriatic arthritis. Ann Rheum Dis 60:iii37, 2001.
Willkens RF, Williams HJ, Ward JR, et al: Randomized, double blind, placebo-controlled trial of low dose pulse methotrexate in psoriatic arthritis. Arthritis Rheum 27:376, 1984.
Iyer S, Yamauchi P, Lowe NJ: Etanercept for severe psoriasis and psoriatic arthritis: observations on combination therapy. Br J Dermatol 146:118, 2002.
Cauza R, Spak M, Cauza K, Hanusch-Enserer U, Dunky A, Wagner E. Treatment of psoriatic arthritis and psoriasis vulgaris with the tumor necrosis factor inhibitor infliximab. Rheumatol Int 22(6):227, 2002.
Mease PJ, Gladman DD, Ritchlin CT, Ruderman EM, Steinfeld SD, Choy EH, Sharp JT, Ory PA, Perdok RJ, Weinberg MA; Adalimumab Effectiveness in Psoriatic Arthritis Trial Study Group.Arthritis Rheum. Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial. Arthritis Rheum 52(10):3279-89, 2005.
Espinoza LR, Zakraoni L, Espinoza CG, et al: Psoriatic arthritis: Clinical response and side effects of methotrexate therapy. J Rheumatol 19:872, 1992.
Gupta AK, Matteson EI, Ellis CN, et al: Cyclosporin in the treatment of psoriatic arthritis. Arch Dematol 125:507, 1989.
Salvarani C, Macchioni P, Olivieri I, et al: A comparison of cyclosporine, sulfasalazine, and symptomatic therapy in the treatment of psoriatic arthritis. J Rheumatol 28:2274, 2001.
Sarzi-Puttini P, Cazzola M, Panni B, et al: Long-term safety and efficacy of low-dose cyclosporin A in severe psoriatic arthritis. Rheumatol Int 21:234, 2002.