DMARDs
Disease-modifying antirheumatic drugs (DMARDs) may relieve more severe symptoms and attempt to slow or stop joint and tissue damage and progression of psoriatic arthritis.
Biologics, such as Enbrel, Humira and Remicade, are also considered DMARDs. They are highly selective agents that target specific internal events in the body that cause psoriasis and psoriatic arthritis.
The following treatments are not listed in any order of importance. Each case must be evaluated individually.
Antimalarials
Antimalarial treatment, commonly used with success in rheumatoid arthritis, has sometimes been used to treat psoriatic arthritis.
Antimalarials are usually given as a pill once a day. It may take many months before seeing benefits. Side effects include vision changes (blurring, halos around lights, sensitivity to light), headache, dizziness, nausea and vomiting. Individuals taking an antimalarial should have eye examinations periodically. The most commonly prescribed antimalarial is Plaquenil.
Some antimalarials can cause skin psoriasis to get worse in some individuals. Talk to your doctor about the available antimalarial treatments and alternatives.
Biologics
Enbrel
The FDA approved the use of Enbrel (also known by its generic name etanercept) for patients with moderate to severe psoriatic arthritis in January 2002. Enbrel was originally approved for rheumatoid arthritis in 1998. Enbrel was FDA-approved in April 2004 for treating psoriasis.
Studies have also shown that Enbrel reduced the progression of joint damage for two years among psoriatic arthritis patients using the treatment.
Treatment with Enbrel consists of once- or twice-weekly, subcutaneous (under the skin) self-injections. The recommended dose for adult patients with psoriatic arthitis is 50 milligrams (mg) per week.
Enbrel works by suppressing a specific cellular "messenger" called tumor necrosis factor-alpha (TNF-alpha) that is involved in triggering inflammation.
Read more about biologics section or the Enbrel.
Humira
Humira (also known by its generic name adalimumab) is a biologic medication approved by the FDA in October 2005 to treat psoriatic arthritis. It is also approved to treat rheumatoid arthritis. It is being studied for the treatment of psoriasis, and some doctors are already prescribing it "off label" for this disease—common and accepted medical practice.
Treatment of psoriatic arthritis with Humira consists of 40 mg, subcutaneous self-injections every other week.
Similar to Enbrel, Humira works by supressing TNF-alpha.
Read more about biologics or Humira.
Remicade
Remicade (also known by its generic name infliximab) is a biologic medication approved in May 2005 by the FDA to treat psoriatic arthritis. Remicade is also approved for ankylosing spondylitis, ulcerative colitis, rheumatoid arthritis and Crohn's disease. It is being studied for the treatment of psoriasis, and some doctors are already prescribing it "off-label" for this disease.
Treatment of psoriatic arthritis with Remicade calls for patients to receive 5 mg per kilogram (kg) in three infusions in a doctor's office during the first six weeks of treatment. During an infusion, the patient sits in a chair or lies on an examination table and the medication is administered by IV in the course of about two hours. After the first three treatments, patients continue to receive Remicade infusions at regular intervals of eight weeks.
Similar to Enbrel and Humira, Remicade is an anti-TNF-alpha drug.
Read more about biologics or Remicade.
Corticosteroids
Steroid medications taken orally (by mouth) are not generally recommended for long-term treatment of psoriatic arthritis, although in some circumstances they may be needed for relief of acute, severe joint inflammation and swelling. For the most part, large doses of steroids should be avoided because of the potential of making psoriasis lesions worse after the steroid treatment is discontinued.
Occasionally, severe forms of psoriasis, such as pustular
psoriasis, may be provoked by the use of systemic steroids. However, selective low-dose steroid injections to inflamed joints, tendons and the area around joints can improve range of motion.
Cyclosporine
Cyclosporine is an immunosuppressive drug that is FDA-approved for treating psoriasis, and it may produce improvement in psoriatic arthritis. Periodic blood tests are required due to the possibility of kidney damage. For more information, request the Psoriasis Foundation educational booklet Systemic Medications: Internal Drugs for Moderate to Severe Psoriasis.
Gold (chrysotherapy)
Both injection of gold salts and administration of gold capsules by mouth have been reported to be effective in treating arthritis affecting the limbs, but not for treating arthritis of the spine. This treatment also has been reported to be beneficial for rheumatoid arthritis. Its use has declined somewhat in recent years as new treatments have been developed.
Imuran
Imuran is an immunosuppressive drug approved for use in arthritis. It has potent anti-inflammatory effects. Skin lesions may respond to the treatment as well. Blood tests must be performed periodically.
Methotrexate
Methotrexate, an immunosuppressive drug, is FDA-approved for treating psoriasis, and is used widely and successfully for treating psoriatic arthritis and rheumatoid arthritis. It can be effective at relieving the symptoms associated with psoriatic arthritis, and it may help prevent joint destruction.
Methotrexate usually is well tolerated in low doses. However, it potentially has a number of side effects and the long-term potential of damaging the liver. With careful management and dosage, the drug can be used safely for years by certain individuals. A person taking methotrexate should follow a doctor's instructions carefully.
PUVA
PUVA is an acronym for psoralen (a light-sensitizing medication) combined with exposure to ultraviolet light A. It may improve psoriatic arthritis. Generally it is used in combination with other medications. It is not helpful in treating psoriatic arthritis of the spine.
PUVA is FDA-approved for the treatment of moderate to severe cases of psoriasis. It has few short-term side effects, but it has the long-term potential to increase the risk of skin cancers. For more information, request the Psoriasis Foundation educational booklet Light Therapy.
Retinoids
Soriatane, a systemic retinoid FDA-approved for severe skin psoriasis, may be effective for some psoriatic arthritis patients. Oral retinoids carry the risk of birth defects in women of child-bearing potential, and the rare possibility of producing skeletal side effects with long-term use. Read more about systemics.
Sulfasalazine
Sulfasalazine, a sulfa drug developed to treat inflammatory bowel diseases, is sometimes used for psoriatic arthritis. Approximately one-third of psoriatic arthritis patients respond rapidly to this treatment (usually within four to eight weeks).
Sulfasalazine is a tablet given in evenly divided doses over a 24-hour period of time. Use of sulfasalazine is not recommended in patients with sulfa allergies, people with intestinal or urinary obstructions and individuals suffering from porphyria, a metabolism disease. A doctor may require regular blood tests while a patient is on sulfasalazine to monitor cell counts and liver enzymes. Possible side effects include nausea, rash, headache, abdominal pain, vomiting, fever and dizziness.
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