What treatments are out there?
What treatments are out there?
There are a lot of treatments available for psoriatic arthritis (PsA), so it may feel a bit overwhelming to think about them all.1 If you also have psoriasis (PsO), you may also need treatment for skin lesions.1 Different treatments work in different ways and are suitable for different situations,2 so it’s important to work with your healthcare professional to find what’s right for you. Here are the main treatment groups - find out more about what’s out there for PsA, and for PsO.
Systemic therapy >
Pills or injections that act by spreading throughout the body2
Biological therapy >
Injections or infusions made from protein4
Topical therapy >
Used externally for psoriasis skin lesions14
Phototherapy >
Treatment for psoriasis skin lesions using ultraviolet rays15
Systemic therapy: Pills or injections that act throughout the entire body2
The first systemic therapy you would usually be offered is a synthetic DMARD, or disease-modifying drug, like methotrexate, which suppresses an overactive immune system in psoriatic diseases like PsA and PsO.2,4 If you and your healthcare professional decide that methotrexate isn’t appropriate, or it isn’t effective, some other options may include:4,10
- Acitretin, which reduces how fast your skin grows, and is used to treat PsO symptoms
- Apremilast, which changes the way your body deals with inflammation
- Ciclosporin, another drug that suppresses the immune system
- Corticosteroids can be administered orally or injected into the joint to control inflammation
- Other synthetic DMARDs, or disease-modifying drugs, have been shown to reduce and even completely stop the inflammatory activity of the disease, improving joint and skin symptoms. Examples other than methotrexate are leflunomide or sulfasalazine
- Fumaric acid esters, which normalise the balance of cytokines in your body, which are chemicals related to the immune system
- NSAIDs (non-steroidal anti-inflammatory drugs) are a large group of anti-inflammatory drugs that can be taken for prolonged periods
- Januse Kinase Inhibitors or JAK’s, which change the way your body deals with inflammation
Biological therapy: Injections or infusions made from protein4,11
Biological medications are a type of non-synthetic DMARD, or disease-modifying drug, for PsA, PsO and other conditions that work within the body.3,11,12 They are grown in a lab using living cells and target specific parts of the immune system.11 These should only be prescribed by a specialist doctor with experience treating PsA or PsO, although your symptoms and side effects may be monitored by a clinical nurse specialist.4
There are a number of different types of biological treatment currently approved to treat PsA and PsO:
- TNF inhibitors: these block an important protein for inflammation, called tumour necrosis factor (TNF).11 Treatments like this are injected under the skin or directly into a vein. Examples of this type of treatment are adalimumab, etanercept or infliximab, which needs to be done in a hospital.11
- IL-12/23 inhibitors: these block a specific part of the proteins called interleukins (IL) 12 and 23, which are also involved in inflammation.11 Treatments like this are injected under the skin.4 An example of this type of treatment is ustekinumab.11
- IL-17 inhibitors: these block a protein called IL-17 to stop inflammation from developing. Treatments like this are injected under the skin.11 Examples of this type of treatment are ixekinumab or secukinumab.11
- IL-23 inhibitors: treatment that targets a specific part of the protein called IL-23 to block inflammation using an injection under the skin.4,11 An example of this type of treatment is guselkumab, risankizumab.11
If you’re going to be taking a biologic, you will probably need to be tested for tuberculosis (TB) and have blood tests before and during treatment.13
Topical therapy: Used externally for psoriasis skin lesions14
If you also have PsO (psoriasis), topical therapy is usually the first treatment used for mild cases.14 There is a wide variety available, including:14
- Creams
- Lotions
- Gels
- Ointments
- Shampoos
If you also have skin plaques, topical treatments containing emollients may hydrate the skin and stop it drying out, or contain other ingredients, like vitamin D, coal tar or corticosteroids, but can take time to apply.14 If you’re taking corticosteroids, some types should only be used for a short while, so ask your healthcare professional whether you should take breaks from applying these.14
Phototherapy: Treatment for psoriasis skin lesions using ultraviolet rays15
If you have PsO as well as PsA and it hasn’t improved as much as you or your healthcare professional would like with treatments applied to your skin, you may be offered short wave ultraviolet B (UVB) phototherapy 2-3 times a week.15 Another type of phototherapy you could be offered is long wave ultraviolet A (UVA) light in combination with a chemical called psoralen in tablet form.15 This is called P-UVA and is often used to treat pustules on the palms and soles of the feet, although it can’t be used in pregnant women or some people who are at a higher risk for skin cancers.15
TOP TIP
If you want to know more about a treatment, ask your healthcare professional.
You may be interested in
How to prepare to see your doctor
Make every moment of the consultation really count.
Record how you’re feeling
It can be easy to lose track of how you’re doing if you don’t take note.
How to meet people with PsA
You’re not alone – there are other patients with psoriatic arthritis, just like you out there.
References
- Creakyjoints. Available at: https://creakyjoints.org/education/psoriatic-arthritis/treatment/1.https://creakyjoints.org/education/psoriatic-arthritis/treatment/. Accessed: October 2021.
- NHS. Psoriatic arthritis. Available at:https://www.nhs.uk/conditions/psoriatic-arthritis/ Accessed: October 2021.
- Arthritis Ireland. Psoriatic Arthritis. Available at: https://www.arthritisireland.ie/psoriatic-arthritis Accessed: October 2021.
- NHS. Psoriatic Arthritis.https://www.nhs.uk/conditions/psoriatic-arthritis/ Accessed: October 2021.
- Versus Arthritis. Ciclosporin. Available at: https://www.versusarthritis.org/media/1346/ciclosporin-information-booklet.pdf Accessed: October 2021.
- NICE. Apremilast for treating active psoriatic arthritis. Available at: https://www.nice.org.uk/guidance/ta433 Accessed: October 2021.
- Ceglowska U, et al. Value in Health 2014: PSS6.
- Arthritis Ireland. How is Psoriatic Arthritis Treated? Available at: https://www.arthritisireland.ie/psoriatic-arthritis Accessed: October 2021.
- AAD. Psoriatic arthritis treatment. Available at: https://www.aad.org/public/diseases/psoriasis/psoriatic-arthritis-treatment Accessed: October 2021.
- National Psoriasis Foundation. Biologics. Available at: https://www.psoriasis.org/about-psoriasis/treatments/biologics Accessed: October 2021.
- NHS. Biological and biosimilar medicines. Available at: https://www.nhs.uk/conditions/biological-and-biosimilar-medicines/ Accessed: October 2021.
- British Association of Dermatologists. Guidelines for biologic therapy. Available at: https://www.bad.org.uk/shared/get-file.ashx?id=5835&itemtype=document Accessed: October 2021.
- British Association of Dermatologists. Topical treatments for psoriasis. Available at: https://www.bad.org.uk/shared/get-file.ashx?id=123&itemtype=document Accessed: October 2021.
- GP Notebook. Phototherapy in psoriasis. Available at: GP Notebook. Phototherapy in psoriasis. Available at: https://gpnotebook.com/simplepage.cfm?ID=1584070677 Accessed: October 2021.
- GP Notebook. Phototherapy in psoriasis. Available at: GP Notebook. Phototherapy in psoriasis. Available at: https://gpnotebook.com/simplepage.cfm?ID=1584070677 Accessed: October 2020.
