According to the Annals of Rheumatic Disease, somewhere between 6 and 42 percent of people with psoriasis, a common skin condition involving scaly, itchy rashes, also have a serious joint disease called psoriatic arthritis. Psoriatic arthritis is an autoimmune disease in which the body’s natural defenses against infection attack its own tissues instead, causing damage, pain and swelling.

As with other inflammatory forms of arthritis like rheumatoid arthritis (RA), people with psoriatic arthritis may experience flares, periods of intense disease activity when symptoms are at their worst.

Psoriatic arthritis can affect joints throughout the body. For example, one of the first signs of PsA is often in the fingernails, which can become pitted, develop white patches or lift from the nail bed entirely. Another common feature is a sausage-like swelling along the entire length of the fingers and toes, a condition called dactylitis. Other people experience pain and stiffness in the lower back at the sacroiliac joint. Some will experience enthesitis, painful inflammation where tendons and ligaments attach to bones. This condition most commonly affects the heel (Achilles tendonitis) and the bottom of the foot (plantar fasciitis). The pain, fatigue, swelling and difficulty using joints may that result from this condition can limit your ability to participate in daily activities.

Accurate diagnosis and early, aggressive treatment of psoriatic arthritis are important. In PsA, the immune system, which normally protects the body, goes awry. It causes inflammation that if not properly treated, over time can lead to deterioration in joints and the structures (muscles, tendons and ligaments) that support them. Luckily, there are a number of treatments, both over-the-counter (OTC) and prescription, available. The former treat symptoms of both psoriasis and psoriatic arthritis, the latter address the actual causes of inflammation. In addition, there are many self-care strategies you can use to manage your symptoms and feel better overall.

Prescription Medications for Psoriatic Arthritis

In recent years, the array of prescription drugs to both treat psoriatic arthritis symptoms and to halt the disease process that causes inflammation has grown. Options your doctor, typically a rheumatologist who specializes in joint diseases, can prescribe include nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs), including a new category called biologic response modifiers (biologics). They can also prescribe topical agents to ease skin irritation and scaling of psoriatic lesions.

Prescription drugs for psoriatic arthritis include:

NSAIDs: These are usually taken by mouth, although some are available in topical form. They reduce inflammation along with the pain and swelling that accompanies it. Among the most well known are ibuprofen (Advil, Motrin, Nuprin) and naproxen sodium (Aleve), although there are many others. NSAIDs carry risks, including stomach irritation that could become severe. Acetaminophen (Tylenol), an analgesic, may be added to NSAIDs to provide additional pain relief, although it won’t address inflammation. NSAIDs carry risks most notably that of heart attack and stroke, along with stomach irritation that could become severe. COX-2 inhibitors like celecoxib (Celebrex) are specially formulated NSAIDs that cause less stomach damage.

Corticosteroids: These drugs are designed to mimic the anti-inflammation hormone cortisol, which is normally produced by the body’s adrenal glands. Prednisone, taken orally, can help reduce inflammation in the short term, but long-term use is inadvisable due to unpleasant side effects such as facial swelling and weight gain. Directly injecting corticosteroids into affected joints can provide temporary inflammation relief.

DMARDs: These drugs work to reduce or prevent joint inflammation and damage. They can be taken by mouth, by injection (either given at your doctor’s office or at home by you) or by infusion into the veins (only administered by a healthcare professional).  According to the American College of Rheumatology, the DMARDs most commonly prescribed for psoriatic arthritis are sulfasalazine (Azulfidine), methotrexate (Rheumatrex, Trexall), cyclosporine (Neoral, Sandimmune) and leflunomide (Arava). Azathioprine (Azasan, Imuran) may also be prescribed.

Biologics: Developed over the last decade, this subset of DMARDs stop inflammation at the cellular level. There are two types of biologics approved to treat psoriatic arthritis. The first type suppresses tumor necrosis factor alpha (TNF-alpha), a specific protein produced by immune cells to signal other cells it’s time to start the inflammatory process. These include etanercept (Enbrel), adalimumab (Humira) and golimumab (Simponi), which are given by injection, and infliximab (Remicade), which is given by infusion in a doctor’s office. The second type was approved to treat psoriatic arthritis in 2013 and targets two proteins that can trigger inflammation. It is called ustekinumab (Stelara) and is given by injection. A TNF blocker called certolizumab (Cimzia) was also approved to treat psoriatic arthritis in 2013, and is given by injection. While biologics have shown powerful results, they suppress the immune system and may raise the risk of infections.