Ask the Rheumatologist: Treatment Tips for Psoriatic Arthritis

1. How can I prevent damage to my joints?

The best way to prevent damage is to control the inflammation in your joints. The inflammatory process occurs within joints, around tendons and ligaments, and where they insert on bone.

You can reduce inflammation by following an anti-inflammatory diet, reducing stress, getting good quality sleep, exercising, and taking your medications as prescribed.

Also, if your joints are inflamed, minimize using those joints until the inflammation subsides. Gentle exercise and moving your joints through their full range of motion will maintain their function. You may want to seek out help from an occupational or physical therapist.

2. My treatment has stopped working. What are my options?

If this happens, make an appointment with your doctor to review what medications you’ve been on, how well they’ve worked, and your disease pattern and severity.

Also discuss new treatment options, what types of medications are available, and what their side effects are. You and your doctor can also factor in insurance coverage and out-of-pocket costs to determine which treatment is best. It’s also important to review your diet, stressors, recent infections, and physical activities to see what additional options are available.

There are several FDA-approved medications for psoriatic arthritis (PsA). They fall into groups based on the way they block specific immune pathways.

Oral medications fall into either disease-modifying antirheumatic drugs (DMARDs), janus kinase inhibitors, or phosphodiesterase-4 inhibitors. The biologics that are usually used first are called TNF-blockers, and there are five to choose from. Additional options that block other immune pathways include interleukin-17 (IL-17) inhibitors, IL-12 and IL-23 inhibitors, and T-cells.

3. Is there anything I can do to prevent flare-ups?

Keep a brief record of your flares and what led to them and look for patterns. Certain foods, increased stress, or infections may trigger flares. Other times, they just happen spontaneously.

When a flare does occur, it’s important to rest and take extra good care of yourself. Treating your flares early can minimize your symptoms and the risk of damage.

You may need to talk to your doctor about increasing or changing your medications. Sometimes, your doctor may recommend a local steroid injection into the inflamed joint.

4. What tests will a rheumatologist use to monitor my psoriatic arthritis?

Your doctor will likely monitor your PsA with blood tests like the erythrocyte sedimentation rate test and C-reactive protein test.

If you have another medical condition like diabetes or liver disease, glucose and liver-function testing will be done. If you’re on certain medications, your doctor may conduct tests that are specific to those drugs. Common tests include a complete blood count (CBC) and a renal function test (serum creatinine).

Your doctor may also recommend an ultrasound to evaluate for the presence of inflammation in a joint, finger, or toe. An advantage of the ultrasound is that it doesn’t use radiation like an X-ray and can often be done in your doctor’s office.

5. What topical treatment options are there?

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) can sometimes be helpful for a single joint. Topicals containing aspirin-like medications are available without a prescription. The prescription topicals contain the NSAID diclofenac.

If psoriasis is also present with PsA, there are a number of topical treatments available.

6. What injectable treatment options are there?

If a single or a few joints or tendons are active, a local steroid injection can be very helpful.

Your doctor may recommend treating your PsA with a biologic. If this is the case, all of the biologics are given by self-injection. Less commonly, the biologic will be given intravenously in your doctor’s office or an infusion center.

7. How long until I see results from my treatment?

It may take up to three months before you see the full effect of a new treatment. In my experience, though, improvement usually occurs within several weeks, and often after a single injection of a biologic medication.

In the early stages when starting a new treatment, your doctor may need to increase a medication dose or add a second drug before you see results.

8. My symptoms are severely impacting my daily life. What can I do?

Make sure your treatment is optimized. Also, consult with a physical or occupational therapist.

Occupational therapists can help with evaluating your work activities, daily living activities, and hobbies. They can also give recommendations to improve your symptoms and function. Sometimes, they may recommend that you take time off from work, either for a vacation or on disability leave.

Dr. Carteron is an immunologist and rheumatologist. She graduated from The Johns Hopkins University School of Medicine. She’s a clinical faculty member in Medicine at the University of California, San Francisco, mentoring rheumatology fellows in-training. She also provides consultative services to individual patients, biopharma, and nonprofit organizations. She is cofounder of the HealthWell Foundation and a Women’s Health Program. Her work focuses on Sjogren’s syndrome, an autoimmune disease, and she is Chair of Rheumatology Clinical Practice Guidelines for the Sjogren’s Syndrome Foundation. She enjoys time in Napa Valley with family and serving as an intercessor.