What treatments are out there?

There are a lot of treatments available for psoriatic arthritis (PsA),^[1] and it may feel a bit overwhelming to think about them all. 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 throughout the entire body^[2]

The first systemic therapy you would usually be offered is a synthetic DMARD, or disease-modifying drug,^[2] like methotrexate,^[3] which suppresses an overactive immune system in psoriatic diseases like PsA^[2] and Pso.⁴ If you and your healthcare professional decide that methotrexate isn’t appropriate, or it isn’t effective, some other options may include:

• Acitretin, which reduces how fast your skin grows, and is used to treat Pso symptoms⁴
• Apremilast, which changes the way your body deals with inflammation⁵
• Ciclosporin, another drug that suppresses the immune system⁶
• Corticosteroids, which can be administered orally or injected into the joint to control inflammation^[2]7
• Other synthetic DMARDs, which have been shown to reduce and even completely stop the inflammatory activity of the disease, improving joint^[2] and skin symptoms.⁴ Examples other than methotrexate are leflunomide or sulfasalazine^[2]
• Fumaric acid esters, which normalise the balance of cytokines, or chemicals related to the immune system, in your body⁸⁹
• NSAIDs (non-steroidal anti-inflammatory drugs), which are a large group of anti-inflammatory drugs that can be taken for prolonged periods⁷¹⁰

Biological therapy: Injections or infusions⁴ made from protein¹¹

Biological medications are a type of non-synthetic DMARD, or disease-modifying drug, for PsA,^[3] Pso and other conditions that work on certain areas of the body.¹¹¹² They target specific parts of the immune system that play a major role in developing PsA and Pso.¹² These treatments should be prescribed by a specialist doctor with experience treating PsA or Pso, and you may be monitored while on treatment.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).¹² Treatments like this are injected under the skin or directly into a vein,⁴ which needs to be administered in a hospital. Examples of this type of treatment are adalimumab, etanercept or infliximab.¹²
• IL-12/23 inhibitors: these block a specific part of the proteins called interleukins (IL)-12 and 23, which are also involved in inflammation.¹² Treatments like this are injected under the skin.¹¹ An example of this type of treatment is ustekinumab.¹²
• IL-17 inhibitors: these block a protein called IL-17 to stop inflammation from developing.¹² Treatments like this are injected under the skin.¹² Examples of this type of treatment are ixekinumab or secukinumab.¹²

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

JAK inhibitors: Tablets that block enzymes linked with inflammation¹⁴

Janus kinase inhibitors, or JAK inhibitors, block enzymes associated with inflammation so that the body no longer produces the proteins that cause PsA symptoms.¹⁴ An example of this type of treatment is upadacitinib.¹⁴

Topical therapy: Used externally for psoriasis skin lesions¹⁵

If you also have Pso (psoriasis), topical therapy is usually the first treatment used for mild cases.¹⁵ There is a wide variety available, including:¹⁵

• 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.¹⁵ 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.¹⁵

Phototherapy: Treatment for psoriasis skin lesions using ultraviolet rays¹⁶

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.¹⁶ 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.¹⁶ 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.¹⁶