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.
Catherine Burt Driver, MD
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
In this Article
- Psoriatic arthritis facts
- What is psoriatic arthritis?
- What causes psoriatic arthritis?
- What are risk factors for developing 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 are complications of psoriatic arthritis?
- What is the outlook (prognosis) for patients with psoriatic arthritis?
- Can psoriatic arthritis be prevented?
- Is there a psoriatic arthritis diet?
- 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.
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.
Medications that block the chemical messenger known as tumor necrosis factor (TNF) are another treatment option for moderate to severe psoriatic arthritis. The TNF-blockers etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), golimumab (Simponi), and certilizumab pegol (Cimzia) are also referred to as biologic medications and can be very effective for severe psoriatic arthritis. They can significantly improve or eradicate both the psoriasis and the arthritis as well as stop progressive joint damage. These medications are given intravenously or by injections. There is an increased risk of infection while taking biologic medications and patients are screened for underlying tuberculosis prior to TNF-blocker administration.
Ustekinumab (Stelara) is an injectable biologic medication that is used to treat severe plaque psoriasis and psoriatic arthritis with or without methotrexate. This biologic works by blocking chemical messengers called interleukins. There is an increased risk of infections while taking ustekinumab.
Apremilast (Otezla) is an oral medicine approved for the treatment of patients with moderate to severe plaque psoriasis for whom phototherapy or systemic therapy is appropriate and for the treatment of adult patients with active psoriatic arthritis. Apremilast works by inhibiting an enzyme called phosphodiesterase 4 (PDE4). Apremilast can have side effects, including an increase in depression and gastrointestinal upset such as diarrhea and nausea.
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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