A team of healthcare professionals are likely to be involved in your treatment. Your doctor (usually a rheumatologist) will be responsible for your care, although a specialist nurse may also be involved in monitoring your condition and treatments.
You may also see:
- a physiotherapist, who can give you advice on exercises to help maintain your mobility
- an occupational therapist, who can give you advice on protecting your joints from further damage, for example, by using splints or altering the way you perform tasks to reduce the strain on your joints
- a podiatrist, who can assess your footcare needs and offer advice on special footwear.
Read more about feet and footwear and the rheumatology team.
Read more about physiotherapy and arthritis and occupational therapy and arthritis.
Treatments for the arthritis
Non-steroidal anti-inflammatory drugs (NSAIDs) act by blocking the inflammation that occurs in the lining of your joints. They can be very effective in controlling pain and stiffness. Usually you'll find your symptoms improve within hours of taking these drugs but the effect will only last for a few hours, so you have to take the tablets regularly.
Some people find that NSAIDs work well at first but become less effective after a few weeks. In this situation, it sometimes helps to try a different NSAID. There are about 20 available, including ibuprofen, diclofenac, indometacin and naproxen.
Like all drugs, NSAIDs can have side-effects, so your doctor will reduce the risk of these, by prescribing the lowest effective dose for the shortest possible period of time.
NSAIDs can cause digestive problems (stomach upsets, indigestion or damage to the lining of the stomach) so in most cases NSAIDs will be prescribed along with a drug called a proton pump inhibitor (PPI), such as omeprazole, that will help to protect the stomach.
NSAIDs also carry an increased risk of heart attack or stroke. Although the increased risk is small, your doctor will be cautious about prescribing NSAIDs if there are other factors that may increase your overall risk, for example, smoking, circulation problems, high blood pressure, high cholesterol or diabetes.
Disease-modifying anti-rheumatic drugs (DMARDs)tackle the causes of inflammation. They change the way the disease progresses and hopefully will stop your arthritis from getting worse. It may be several weeks before DMARDs start to have an effect on your joints, so you should keep taking them even if they don't seem to be working. Sometimes these drugs are given by injection.
The decision to use DMARDs will depend on a number of factors, including how active the arthritis and psoriasis are and the likelihood of joint damage.
Examples of DMARDs include:
Biological therapies are newer drugs that may be used if other DMARDs aren’t working well. These are given by injection into the skin or through a drip into a vein (an intravenous infusion). Biological therapies used for treating psoriatic arthritis include:
When taking almost all DMARDs you’ll need to have regular blood tests at your GP's practice, and in some cases a urine test. The tests allow your doctor to monitor the effects of the drug on your condition but also to check for possible side-effects, including problems with your liver, kidneys or blood count.
You can take NSAIDs along with DMARDs, and some people may need to take more than one DMARD at a time.
Steroid injections are often recommended for joints that are particularly troublesome or when ligaments and tendons become inflamed. When steroids are used for people with psoriasis and psoriatic arthritis, there's a risk that the psoriasis can get worse. You should discuss this with your doctor if steroids are suggested.
However, steroid tablets aren't generally used for psoriatic arthritis.
Treatments for the skin
Your skin will usually be treated with ointments. There are five main types:
- tar-based ointments
- ointments made from a medicine called dithranol – this helps to control the processes that affect the production of skin cells, and it's very important not to let these ointments come into contact with normal skin as they may 'burn' the skin
- steroid-based creams and lotions
- vitamin D-like ointments such as calcipotriol and tacalcitol
- vitamin A-like (retinoid) gels such as tazarotene
If the creams and ointments don't help your psoriasis, your doctor may suggest:
- light therapy (also called phototherapy), involving short spells of exposure to high-intensity ultraviolet light carried out in hospital
- retinoid tablets
- methotrexate tablets or injections.
Many of the DMARDs used for psoriatic arthritis will also help your skin condition. Similarly, some of the treatments for your skin may help your arthritis.
Treatments for nail psoriasis are usually less effective than the skin treatments. Many people use nail varnish to make the marks less noticeable.
People with psoriatic arthritis don’t often need surgery. Very occasionally a damaged tendon may need surgical repair. And sometimes, after many years of disease, a joint that has been damaged by inflammation is best treated with joint replacement surgery.
If the psoriasis is bad in the skin around the affected joint, your surgeon may recommend a course of antibiotic tablets to help prevent infection. Sometimes psoriasis can appear along the scar left by the operation, but this can be treated in the usual way.