Treatment

No cure exists for psoriatic arthritis. Treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability and controlling skin involvement. One of the most common treatments are prescription medications called disease-modifying antirheumatic drugs (DMARDs).

Treatment will depend on how severe your disease is and what joints are affected. You might have to try different treatments before you find one that brings you relief.

Medications

Drugs used to treat psoriatic arthritis include:

• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation for people with mild psoriatic arthritis. NSAIDs available without a prescription include ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Stronger NSAIDs are available by prescription. Side effects can include stomach irritation, heart problems, and liver and kidney damage.

• Conventional DMARDs. These drugs can slow the progression of psoriatic arthritis and save joints and other tissues from permanent damage.

  The most commonly used DMARD is methotrexate (Trexall, Otrexup, others). Others include leflunomide (Arava) and sulfasalazine (Azulfidine). Side effects can include liver damage, bone marrow suppression, and lung inflammation and scarring (fibrosis).

• Biologic agents. Also known as biologic response modifiers, this class of DMARD targets different pathways of the immune system. Biologic agents include adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), ustekinumab (Stelara), secukinumab (Cosentyx), ixekizumab (Taltz), guselkumab (Tremfya) and abatacept (Orencia). These drugs can increase the risk of infections.
• Targeted synthetic DMARDs. Tofacitinib (Xeljanz) might be used if conventional DMARDs and biologic agents haven't been effective. Higher doses of tofacitinib can increase the risk of blood clots in the lungs, serious heart-related events and cancer.
• Newer oral medication. Apremilast (Otezla) decreases the activity of an enzyme in the body that controls the activity of inflammation within cells. Apremilast is used for people with mild to moderate psoriatic arthritis who do not want or cannot be treated with DMARDs or biologic agents. Potential side effects include diarrhea, nausea and headaches.

Therapies

Physical and occupational therapies might ease pain and make it easier to do everyday tasks. Ask your doctor for referrals. Massage therapy might also offer relief.

Surgical and other procedures

• Steroid injections. Injections into an affected joint can reduce inflammation.
• Joint replacement surgery. Some joints that have been severely damaged by psoriatic arthritis can be replaced with artificial ones made of metal and plastic.