Psoriatic Arthritis Treatment: Effective Options and Management Strategies

The most common NSAIDs available OTC include:

• Aspirin
• Ibuprofen
• Naproxen

If OTC NSAIDs don't help, there are also some prescription-strength NSAIDs your doctor can try, including:

• Celecoxib (Celebrex)
• Diclofenac (Voltaren)
• Fenoprofen (Nalfon)
• Indomethacin (Indocin)
• Ketorolac (Toradol)

In general, don't take NSAIDs continuously for more than 10 days for pain unless your doctor says it's okay. Even if your doctor says it's okay, watch out for any side effects, such as stomach pain or heartburn. Long-term use of NSAIDs can cause some people to develop ulcers or stomach bleeding, as they lead to thinning of the lining that protects your stomach.

Make sure your doctor knows your medical history. In general, it's safest to avoid taking NSAIDs if you have:

• Stomach ulcers or bleeding in your digestive system
• Kidney or liver disease
• Gastroesophageal reflux disease (GERD or chronic acid reflux)
• Crohn's disease or ulcerative colitis
• Diabetes that isn't yet under control
• High blood pressure that's hard to manage
• Bleeding disorders
• Heart failure
• A history of heart attack or stroke
• Pregnancy (or if you plan to get pregnant soon)
• You drink alcohol every day
• You have asthma that gets worse when you take aspirin
• You're 65 or older

DMARDs for Psoriatic Arthritis Treatment

If your psoriatic arthritis symptoms are mild to moderate or don't respond well to NSAIDs, your doctor may prescribe you a disease-modifying antirheumatic drug (DMARD). DMARDs are probably best known as medicines for rheumatoid arthritis, but they're also used to treat a lot of other autoimmune conditions, such as psoriatic arthritis and multiple sclerosis. These work by preventing your immune system from attacking your tissues. They can do this in a couple of different ways — by stopping a specific path of your immune system or by targeting individual proteins in your immune system. This ultimately slows or stops your pain, swelling, and joint and tissue damage.

There are two different types of DMARDs: traditional DMARDs and biologics. Traditional DMARDs are older medicines that stop a specific pathway of your immune system. Your doctor may try them first since they tend to be cheaper. They usually also come in pill form and so are easier to take than most biologics, which usually must be injected under your skin or into a vein. They may also prescribe you a couple of DMARDs to take in combination.

The most common traditional DMARDs include:

• Azathioprine (Imuran, Azasan)
• Hydroxychloroquine (Plaquenil)
• Leflunomide (Arava)
• Methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall)
• Sulfasalazine (Azulfidine)

You usually need to take DMARDs for a couple of months before they start to work. So, your doctor may have you combine a traditional DMARD with an NSAID or a low-dose steroid drug such as prednisone or cortisone until your DMARD starts to work.

Before you start a DMARD, you usually need to have a negative test for tuberculosis and hepatitis B and C because DMARDs can reactivate these infections. They can also be hard on some of your organs. So, you'll also need regular blood tests while you're taking them to make sure they don't harm your kidneys and liver.

Biologics for Psoriatic Arthritis Treatment

If your psoriatic arthritis symptoms are severe, your doctor may prescribe you a biologic. These are a newer type of DMARD that are made using molecular biology techniques. Biologics block specific proteins that cause inflammation and joint damage instead of blocking an entire immune system pathway.

Several different types of biologics target different proteins, such as:

Tumor necrosis factor (TNF) inhibitors

TNF is a protein some of your immune system cells (called macrophages) make, and it causes inflammation. TNF inhibitors stop them from doing this. As of 2024, there are five TNF inhibitors available that are FDA-approved in the U.S. for several autoimmune conditions, including plaque psoriasis and psoriatic arthritis. If you've never taken a biologic before, your doctor will probably prescribe this before they try any other biologics.

TNF inhibitors include:

• Adalimumab (Humira)
• Certolizumab pegol (Cimzia)
• Etanercept (Enbrel)
• Infliximab (Remicade)
• Golimumab (Simponi)

Adalimumab, certolizumab, and etanercept all need to be injected just under the skin (subcutaneously). Golimumab can be injected either under the skin or into your veins using an IV. Infliximab needs to be given via an IV.

Interleukin inhibitors

Interleukins are another protein some of your immune system cells make. They help regulate the way your immune system responds to your environment. Interleukin inhibitors block specific interleukins from working, so they turn down part of your immune system response.

• Anakinra (Kineret). This is an interleukin-1 inhibitor, which is FDA-approved for rheumatoid arthritis. But, it can also be used to treat other inflammatory arthritis conditions, as well. Anakinra must be injected under the skin.
• Sarilumab (Kevzara) and tocilizumab (Actermra). These are interleukin-6 inhibitors. These are approved for rheumatoid arthritis but may be used for psoriatic arthritis treatment, too. Sarilumab must be injected under the skin. Tocilizumab can be either injected under the skin or taken by an IV infusion.
• Secukinumab (Cosentyx), ixekizumab (Taltz), and brodamulab (Siliq). These interleukin-17 inhibitors can treat both your joint and skin symptoms. Your doctor may prescribe you one of these if you also have moderate-to-severe skin symptoms along with your joint symptoms. All of these need to be injected under your skin.

The T-cell inhibitor Abatacept (Orencia). This blocks the action of T cells, a type of immune system cell. This can be injected under your skin or given via IV. 

The B-cell inhibitor rituximab (Rituxan). This blocks the action of another type of immune system cell called a B cell. If you've tried a TNF inhibitor and it hasn't worked or has stopped working, your doctor may suggest you try this. Rituximab must be infused with an IV.

Janus kinase (JAK) inhibitors

JAK inhibitors shut down another immune system pathway that leads to swelling and pain in your joints. JAK inhibitors are available in pill form, so you can take them by mouth. But they're usually not the first medicine your doctor will try because, in most cases, TNF inhibitors and interleukin inhibitors work the best.

• Tofacitinib (Xeljanz)
• Baricitinib (Olumiant)
• Upadacitinib (Rinvoq)

Biologics can be expensive, and they can have side effects and risks. You may get dizzy, feel like you've got a cold, or have a reaction where you get your shot.

Enzyme Inhibitors for Psoriatic Arthritis Treatment

Apremilast (Otezla) is a new kind of drug that's FDA-approved for psoriatic arthritis and plaque psoriasis. It's a small-molecule phosphodiesterase inhibitor. Apremilast specifically stops the activity of an enzyme called phosphodiesterase-4 (PDE4). This turns down some of your inflammatory responses, which is what causes your joint pain and swelling.

Apremilast is available in pill form. Your doctor will generally start you on a low dose and increase your dose gradually. This should help you avoid side effects such as diarrhea, nausea, and vomiting in the first few weeks.

Since these gastrointestinal side effects are common, you may lose weight, especially in the first month or so after you start taking it. So, your doctor will want to watch how you're doing. Another possibly serious side effect is depression and suicidal ideation. So, if you have a history of mood disorders, such as major depression or bipolar disorder, your doctor may want to keep a close eye on you while you adjust to your medicine.

Steroids for Psoriatic Arthritis Treatment

Corticosteroids are powerful anti-inflammatory drugs that can ease severe pain and swelling. They're not the same as the muscle-building type of anabolic steroids. You can take corticosteroids by mouth or inject them directly into a joint or muscle. They are not likely the main way your doctor will treat your psoriatic arthritis. And they can also make your skin symptoms worse.

Long-term use (longer than a few weeks) of systemic corticosteroids — the kind you take by mouth — can cause serious side effects, such as:

• Increased appetite and weight gain
• Muscle weakness
• Easy bruising
• Increased risk of infection
• Acne
• Osteoporosis (bone thinning or weakening)
• Onset of diabetes (or worsening if you already have it)
• Onset of high blood pressure (or worsening if you already have it)
• Trouble sleeping

Therefore, your doctor will prescribe them only when you really need them, for instance, when you have a lot of joint pain and swelling. When they do prescribe them, they will prescribe the lowest dose that helps you feel better and then will wean you off as soon as possible.

Corticosteroids include:

• Cortisone
• Prednisone
• Methylprednisolone

Prednisone is the most common steroid medicine used to treat inflammatory arthritis, but you may also get a cortisone injection in a specific joint or a couple of joints.

Surgeries to Treat Psoriatic Arthritis 

Most people with psoriatic arthritis will never need surgery. But if you have joint damage or bone loss, you may need surgery to help relieve your pain and allow you to move better. The most common surgery that's done for psoriatic arthritis is a joint replacement (also called arthroplasty), where some or all of your joint is replaced with a prosthetic implant made of metal, plastic, or ceramic.

Light Therapy as Psoriatic Arthritis Treatment

Exposing your skin to ultraviolet (UV) light can help get rid of psoriasis skin plaques. You're unlikely to get light therapy for psoriatic arthritis treatment unless you also have skin symptoms that don't respond to medicine.

UV light can damage your skin and possibly lead to skin cancer, so it’s important to follow your doctor's advice when getting light therapy.

Different types include:

Narrowband UVB phototherapy. You’ll probably get it at a clinic to begin with, especially if you have widespread disease. Although phototherapy is also used for localized disease. During the session, you will wear protective coverings for your eyes and genitals, while the rest of your body will be exposed to the light for a few seconds to a few minutes. You’ll probably go about three times a week for 3 months. If you respond well, and your insurance covers the cost, you can get a smaller home unit. It can be a good option if you need weekly treatments to keep you in remission. You’ll still be under a doctor’s supervision.

Lifestyle Changes for Psoriatic Arthritis

You can make some changes that will improve your quality of life:

Eat healthy food. Focus on a healthy eating plan like the Mediterranean diet. Opt for foods that may ease inflammation, like:

• Coldwater fish
• Colorful fresh fruit
• Colorful fresh veggies
• Flaxseed
• Olive oil
• Pumpkin seeds
• Walnuts

Stay away from foods that might cause inflammation, such as:

• Fatty red meat
• Processed food
• Refined sugar
• Dairy products

Exercise: When your joints are sore, you may not want to move. But doing so can:

• Keep your joints and tendons loose
  • Keep the inflammation that comes with this disease in check
  • Lessen the workload on your joints
  • Lower your risk of other conditions that come with psoriatic arthritis, like heart disease, diabetes, and Crohn’s disease

Walking, biking, and swimming are all good options.

• Get to, and stay at, a healthy weight. Almost half the people with psoriatic arthritis are overweight. Studies show that losing just 10% of your body weight can improve your response to medications for psoriasis and psoriatic arthritis.
• Manage your stress. Things that make you worry can also make your psoriatic arthritis worse. Exercise, medication, and talk therapy can all help.
• Rest. Give an achy joint a break. You can go back to what you were doing when you feel better.
• Don’t drink. Mixing some medications for psoriatic arthritis with alcohol can lead to liver damage. Your doctor can let you know if you should quit.

Alternative Therapies for Psoriatic Arthritis

You can try:

Acupressure and acupuncture. These ancient Chinese treatments involve putting pressure on or inserting needles into the body’s healing points or energy lines. Acupressure isn’t proven to help, but studies show that acupuncture can ease your pain.

Curcumin. There’s some proof that this substance, the active ingredient in the spice turmeric, can help curb inflammation.

Massage. It can help stretch your muscles and joints, promote circulation in your lymph system, and help you relax.

Reiki. This Japanese relaxation technique can help you manage stress.

Tai chi. This gentle Chinese exercise helps with relaxation and can ease sore, stiff joints.

Yoga. The controlled movements can relax stiff muscles, ease sore joints, and boost your range of motion. It can also help with pain.

Vitamin D. As an ointment, it’s been used to treat psoriasis for years. You can also get it from foods such as:

• Cod-liver oil
• Coldwater fish such as Sockeye salmon, mackerel, tuna
• Vitamin D-fortified products such as nonfat milk, orange juice, yogurt
• Eggs
• Swiss cheese

Physical therapy. Your physical therapist can come up with a set of exercises, stretches, and therapies that will help relieve your pain and keep you mobile. Check out Physical Therapy for Psoriatic Arthritis to learn more

Always talk to your doctor before you add any supplement or treatment. Look for a practitioner who is certified and, if possible, has experience with people who have psoriasis and psoriatic arthritis.

Get Regular Checkups

Your doctor needs to keep an eye on how your disease is progressing and how well your treatment is working. They also can keep an eye on whether or not you’re getting a related condition (they’ll call it a comorbid condition) such as type 2 diabetes, obesity, depression, or anxiety.

Takeaways

Psoriatic arthritis is a chronic inflammatory arthritis that usually affects people with the skin symptoms of psoriasis or a family member with psoriasis or psoriatic arthritis. The main treatments for psoriatic arthritis include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), which can be either a traditional or a biologic, and a new kind of drug called a phosphodiesterase inhibitor. Your treatment will depend on how severe your disease is, if you have any joint damage, whether you also have skin symptoms, what other health conditions you have, and what medicines you feel comfortable taking.

Psoriatic Arthritis Treatment FAQs

What is the best OTC medicine for psoriatic arthritis?

For mild psoriatic arthritis symptoms, your doctor will likely recommend you take an NSAID such as ibuprofen or naproxen. You can buy these OTC at any pharmacy. But if you have moderate or severe symptoms, it's important to talk to your doctor. You may be risking permanent joint damage if you don't get a more effective long-term treatment, such as a DMARD.