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 protein4,11

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
     

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.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.

 

Living with PsA >

 

You may be interested in:

Make every moment of the consultation really count.

It can be easy to lose track of how you’re doing if you don’t take note.

You’re not alone – there are other patients with psoriatic arthritis, just like you out there.

 

1.    Creakyjoints. Psoriatic arthritis flare-ups. Available at: https://creakyjoints.org/living-with-arthritis/psoriatic-arthritis-flare-ups/ Accessed: June 2020.
2.    NHS. Psoriatic arthritis. Available at: https://www.nhs.uk/conditions/psoriatic-arthritis/ Accessed: June 2020.
3.    Lee MP et al. Arthritis Care Res 2018;70(5): 791-6.
4.    NHS. Psoriasis treatments. Available at: https://www.nhs.uk/conditions/psoriasis/treatment/#:~:text=Steroid%20creams%20or%20ointments%20(topical,from%20mild%20to%20very%20strong. Accessed: June 2020.
5.    Versus Arthritis. Ciclosporin. Available at: https://www.versusarthritis.org/media/1346/ciclosporin-information-booklet.pdf Accessed: June 2020.
6.    NICE. Apremilast for treating active psoriatic arthritis. Available at: https://www.nice.org.uk/guidance/ta433 Accessed: June 2020.
7.    British Association of Dermatologists. Fumaric acid esters. Available at: https://www.bad.org.uk/shared/get-file.ashx?id=84&itemtype=document#:~:text=How%20do%20Fumaric%20Acid%20Esters,which%20are%20upset%20in%20psoriasis.Accessed: June 2020.
8.    Ceglowska U, et al. Value in Health 2014: PSS6.
9.    Arthritis Foundation. NSAIDs. Available at: https://www.arthritis.org/drug-guide/nsaids/nsaids Accessed: June 2020.British Association of Dermatologists. Topical treatments for psoriasis. Available at: https://www.bad.org.uk/shared/get-file.ashx?id=123&itemtype=document Accessed: June 2020.
10.    AAD. Psoriatic arthritis treatment. Available at: https://www.aad.org/public/diseases/psoriasis/psoriatic-arthritis-treatment Accessed: June 2020.
11.    National Psoriasis Foundation. Biologics. Available at: https://www.psoriasis.org/about-psoriasis/treatments/biologics  Accessed: June 2020.
12.    NHS. Biological and biosimilar medicines. Available at: https://www.nhs.uk/conditions/biological-and-biosimilar-medicines/ Accessed: July 2020.
13.    British Association of Dermatologists. Guidelines for biologic therapy. Available at:  https://www.bad.org.uk/shared/get-file.ashx?id=5835&itemtype=document Accessed: June 2020.
14.    British Association of Dermatologists. Topical treatments for psoriasis. Available at: https://www.bad.org.uk/shared/get-file.ashx?id=123&itemtype=document Accessed: June 2020.
15.    GP Notebook. Phototherapy in psoriasis. Available at: GP Notebook. Phototherapy in psoriasis. Available at: https://gpnotebook.com/simplepage.cfm?ID=1584070677 Accessed: June 2020.