Psoriatic arthritis (PA) is a chronic form of inflammatory arthritis. It can develop in people with psoriasis. Psoriasis is a condition of the skin that causes spots of red, scaly skin. There are currently no medications, so treating the symptoms is a priority. Your doctor may prescribe medications to reduce inflammation and pain. There are also natural remedies and lifestyle changes that can help alleviate symptoms and improve the overall quality of life. In this article, we consider the treatment of psoriatic arthritis with drugs.

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The causes of psoriasis and PA are largely unknown. It is believed that genetic, environmental, and immunological factors can contribute to this. The prevalence of the disease is the same for both sexes, as well as in children. Although the disease can affect any age group, patients between the ages of 30 and 50 are at greatest risk.

How to treat psoriatic arthritis

Psoriatic Arthritis Treatment

1. Talk with your doctor. Consulting with your doctor should be your first step if you find any symptoms of psoriasis or psoriatic arthritis. They will be able to diagnose your condition and tell you what actions you should take to manage it.

  • Do not neglect to mention any symptoms to your doctor.
  • Your doctor will also want to know about your family history. People with psoriasis and psoriatic arthritis often have a family history, which also has the disease.  

2. Get a medical diagnosis. Depending on the nature of your psoriasis or PA, your doctor may do a skin biopsy. This will help you learn more about your condition. This is a common procedure in which the doctor anesthetizes part of the psoriatic skin and then cleans some of the cells for examination under a microscope. Your psoriatic arthritis may also require a more thorough examination, and your doctor may do an x-ray.

3. Try an external treatment. Topical treatments for psoriatic arthritis medications include creams, lotions, and shampoos applied to the skin that can relieve your psoriasis. These treatments contain either corticosteroids, salicylic or lactic acid, or retinoids as their active ingredient. Your doctor will help you determine what external treatment — if any — is right for you.

  • Corticosteroids are drugs that mimic cortisol, a natural hormone that reduces inflammation and the activity of the immune system. 
  • Retinoids are a class of drugs made using Vitamin A. They provide better cellular communication, limit the production of skin cells and promote healthy skin.
    • Salicylic or lactic acid treatment is used to reduce the thick layers of scaly skin that accumulate over time due to psoriasis. These acid treatments are often combined with moisturizers or corticosteroids.
    • You can also try dandruff shampoo and mild soap to reduce unnecessary skin irritation.
    • External steroids can cause skin irritation if too much or if too high a concentration is used for too long. Always use the lowest percentage that still helps the symptoms.

    4. Try systemic treatments for psoriatic arthritis medications. While external treatments are used to treat isolated, localized areas of psoriatic skin, more common or persistent cases of psoriasis require a more aggressive approach. There are a number of drugs that can be effective against psoriasis. Methotrexate, cyclosporine, and biology are the most common systemic drugs. 

    • Methotrexate fights psoriasis by slowing the growth of skin cells.
    • Cyclosporin, like methotrexate, slows down cell growth and suppresses the immune system. You should see a difference in the severity of symptoms after about two weeks.
    • Biologics are a class of drugs, not specific drugs. They are administered through a dropper or injection. Biological products are useful in limiting skin inflammation. TNF-alpha inhibitors are one of the most common biological drugs. They prevent inflammation of the skin and joints associated with psoriasis.
    • Methotrexate can cause liver damage, kidney failure, and flu-like symptoms. Other systemic medications, such as cyclosporine, can lead to ulcers, flu-like symptoms, high blood pressure, and an increased chance of infection. Talk with your doctor if you experience these or other side effects after starting treatment. Your doctor will probably adjust the dosage or switch you to another drug. Minimize the power of these side effects by exercising regularly and eating a healthy whole grain diet of fruits and vegetables.
    • Systemic drugs are usually taken daily in liquid or capsule form. Consult your doctor for specific uses.
    • Your doctor may give you oral steroids for outbreaks or at a low dose for treatment. Oral corticosteroid treatment can cause several side effects. For example, you may experience emotional instability, psychosis, anxiety, and depression. You may also develop high blood pressure, diabetes, and an increased chance of getting infected. You can minimize many of these effects with regular exercise. A workout of 30-60 minutes each day has benefits for both the mind and the body. If you suffer from prolonged depression, psychosis, or other disorders of your emotional or mental well-being, talk with your therapist. Let your doctor know, as they may put you on another drug with fewer side effects.

     5.New oral treatment. New “small molecule” treatments can target molecules within the immune cells that cause inflammation, reducing inflammation and swelling of the joints. For example, Apremilast can be taken twice daily as a pill and effectively control swollen joints associated with psoriatic arthritis. These medications are available only as directed by your doctor. Therefore, talk with your doctor if you are interested in treating psoriatic arthritis medications.

    • Similar treatments include ustekinumab and secukinumab.
    • Side effects of apremilast include depression and weight loss. Watch your weight carefully, and if you notice that you are getting too thin, increase your calorie intake. If you suffer from depression due to taking apremilast, talk with friends and family to cheer you up and tell your doctor. They may recommend that you see a physician or reduce the dose to ease your depression.
    • Side effects of ustekinumab and similar drugs include an increased risk of developing certain types of cancer, cerebral edema, fatigue, an increased incidence of infections, and headaches. If you have a headache, try over-the-counter painkillers such as acetaminophen. Consult your doctor for advice on how best to deal with cancer, infectious diseases, and cerebral edema.

    6. There are a number of non-steroidal anti-inflammatory drugs (NSAIDs) that can help relieve pain from cracks, inflamed skin, and joint pain with psoriatic arthritis.

    Symptoms of Psoriatic Arthritis

    Symptoms of psoriasis most often include a rash characterized by spots of red skin covered with white scales. It can also have acne or a charred appearance and is often accompanied by severe itching and burning. These spots are found on the knees, elbows, scalp, arms, legs, lower back, face, or skin fold. Some patients develop small lesions on the palms and soles.

    The relationship between psoriasis and PA depends on the nature of the skin and joint disease. Patients may have a combination of psoriasis and psoriatic arthritis, including the presence or absence of any condition and the varying severity of any condition. In 85% of cases, skin psoriasis will occur, often several years before the onset of joint symptoms. In approximately 15% of patients, skin and joint symptoms appear simultaneously. Given the high occurrence of arthritis in combination on the skin, it is important to talk about any pain with your dermatologist in order to get appropriate and early detection and treatment of psoriatic arthritis with drugs.

    Characteristic signs and symptoms may include:

    • Rigidity. This usually follows periods of immobility and worsens in the morning and improves throughout the day.
    • Soreness. This can occur in the lower back or neck, as well as over the tendons.
    • Itchy or irritated skin. This can occur, usually in the form of spots on the elbows, knees, and scalp.
    • Fatigue. This is a common symptom and may include feeling tired in the morning and feeling overwhelmed.
    • Dactylitis. The swelling of the fingers and toes resembles a sausage.
    • Joint pain. Mostly at the tips of the fingers and toes of the foot, joint pain can also occur in one or more joints.
    • Nail and leg problems. Symptoms of nails begin with the formation of small holes on the surface of the nails (pitting). Then transverse peeling, cracking, discoloration and separation of the nail from the nail bed follow.
    • Red-eye. Pain and redness caused by inflammation, such as conjunctivitis.
    • Ankylosing spondylitis. This disease usually involves the sacroiliac joints of the lower back.

        Inflammation is also common at the sites of attachment of the ligaments and tendons, especially the Achilles tendon located on the back of the leg near the ankle, as well as the plantar fascia located on the sole of the foot. 

        Causes of Psoriatic Arthritis

        The causes of psoriasis are still unknown, so the further development of psoriatic arthritis is also poorly understood. Researchers believe that genetic, environmental, and immunological factors contribute to the development of the disease as follows:

        • Genetics. Support for genetic and environmental hypotheses was formed by studying families, in particular identical twins. In one study, it was found that if one twin develops psoriasis, then in 70% of cases the other twin also develops this disease. 30% of the discrepancies indicate that external environmental factors also act. Studies have shown that in patients with close relatives with the disease, the risk of developing PA is more than 40%.
        • Environment. Nothing proved that a particular environmental factor was to blame. Although researchers believe that infectious agents such as streptococci and staphylococci, as well as physical trauma, are the most likely culprits. Psoriasis can occur where there is a skin injury. In some patients, arthritis may develop in a damaged joint.
          • Immunological Psoriatic arthritis is known to occur in patients with abnormalities of the immune system, as well as human immunodeficiency virus (HIV).

          The presence of a risk factor for the development of psoriasis does not guarantee the development of psoriatic arthritis. See the treatment for psoriatic arthritis with the drugs above. 

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