Psoriatic Arthritis (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Psoriatic arthritis facts
- What is psoriatic arthritis?
- What causes psoriatic arthritis?
- What are psoriatic arthritis symptoms and signs?
- How does the doctor diagnose psoriatic arthritis?
- What is the treatment for psoriatic arthritis?
- Disease-modifying medications
- What is the outlook (prognosis) for patients with psoriatic arthritis?
- Can psoriatic arthritis be prevented?
- What does the future hold for patients with psoriatic arthritis?
- Find a local Rheumatologist in your town
Patients who experience progressive joint destruction in spite of NSAIDs are candidates for more aggressive disease-modifying medications. Disease-modifying medications are important to prevent progressive joint destruction and deformity. These medications include methotrexate, which is used orally or can be given by injection on a weekly basis for psoriatic arthritis as well as for psoriasis alone. It can cause bone-marrow suppression, as well as liver damage with long-term use. Regular monitoring of blood counts and liver blood tests should be performed during therapy with methotrexate.
Antimalarial medication such as hydroxychloroquine (Plaquenil) is also used for persistent psoriatic arthritis. Its potential side effects include injury to the retina of the eye. Regular ophthalmologist examinations are suggested while using this medication.
Sulfasalazine (Azulfidine) is an oral sulfa-related medicine that has also been helpful in some patients with persistent psoriatic arthritis. Traditionally, Azulfidine has been an important agent in the treatment of ulcerative and Crohn's colitis. It should be taken with food, as it too can cause gastrointestinal upset.
Learn more about: Azulfidine
Research has demonstrated effective treatment of both psoriasis and psoriatic arthritis with leflunomide (Arava), a medication that is also used for the treatment of rheumatoid arthritis.
Learn more about: Arava
Medications that block the chemical known as tumor necrosis factor (TNF) are another treatment option for severe cases. The TNF-blockers etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira), and golimumab (Simponi) can be very effective for severe psoriatic arthritis, and they can significantly improve or eradicate both the psoriasis and the arthritis as well as stop progressive joint damage.
Corticosteroids are potent anti-inflammatory agents. Corticosteroids can be given by mouth (such as prednisone) or injected (cortisone) directly into the joints to reduce inflammation. They can have side effects, especially with long-term use. These include thinning of the skin, easy bruising, infections, diabetes, osteoporosis and, rarely, bone death (necrosis) of the hips and knees.
While the relationship between the skin disease and joint disease is not clear, there are reports of improvement of the arthritis simultaneously with clearing of the psoriasis. Patients with psoriasis can benefit by direct sunlight exposure and are often treated with direct ultraviolet light therapy.
Finally, patients who have severe destruction of the joints may be candidates for orthopedic surgical repair. Total hip joint replacement and total knee joint replacement surgery are now commonplace in community hospitals throughout the United States.
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