Disease-modifying Antirheumatic Drugs (DMARDs)
Disease-modifying antirheumatic drugs (DMARDs) may relieve more severe symptoms and attempt to slow or stop joint and tissue damage and progression of psoriatic arthritis.
Antimalarial treatment, commonly used with success in rheumatoid arthritis, has sometimes been used to treat psoriatic arthritis.
Antimalarials are usually given as one or two pills, once a day. It may take many months before seeing benefits. Side effects include vision changes (blurring, halos around lights and sensitivity to light), headache, dizziness, nausea and vomiting. Individuals taking an antimalarial should have eye examinations periodically.
Unless you are directed to do so by your doctor, do not take Plaquenil, the most commonly prescribed antimalarial. The use of Plaquenil may cause a severe flare of psoriasis.
Some antimalarials can cause the skin disease to get worse in some individuals. Talk to your doctor about the available antimalarial treatments and alternatives.
Steroid medications taken by mouth or injection are not generally recommended for long-term treatment of psoriatic arthritis. In some circumstances, they may be needed for relief of acute, severe joint inflammation and swelling. For the most part, large doses of steroids should be avoided. Psoriasis lesions may potentially become worse after the steroid treatment is discontinued.
Severe forms of psoriasis, such as pustular psoriasis, may occasionally be provoked by the use of systemic steroids. However, selective low-dose steroid injections to inflamed joints, tendons and the area around joints can improve range of motion.
Cyclosporine is an immunosuppressive drug that is FDA-approved for treating psoriasis, and it may produce improvement in psoriatic arthritis. Periodic blood tests are required due to the possibility of kidney damage.
Imuran is an immunosuppressive drug approved for use in arthritis. It has potent anti-inflammatory effects. Skin lesions may respond to the treatment as well. Blood tests must be performed periodically.
Leflunomide (brand name Arava) is a rheumatoid arthritis drug that has been prescribed off-label for the treatment of psoriatic arthritis. Leflunomide, which comes in a pill, is beneficial to some people with psoriatic arthritis, according to recent medical studies.
Methotrexate, an immunosuppressive drug, is FDA-approved for treating psoriasis, and is used widely and successfully for treating psoriatic arthritis and rheumatoid arthritis. It can be effective at relieving the symptoms associated with psoriatic arthritis, and it may help prevent joint destruction.
Methotrexate usually is well tolerated in low doses. However, it potentially has a number of side effects and the long-term potential of damaging the liver. With careful management and dosage, the drug can be used safely for years by certain individuals. A person taking methotrexate should follow a doctor's instructions carefully.
Acitretin (also know by its brand name Soriatane), a systemic retinoid FDA-approved for severe skin psoriasis , may be effective for some people with psoriatic arthritis. Oral retinoids carry the risk of birth defects in women of child-bearing potential, and the rare possibility of producing skeletal side effects with long-term use.
Sulfasalazine, a sulfa drug developed to treat inflammatory bowel diseases, is sometimes used for psoriatic arthritis. Approximately one-third of psoriatic arthritis patients respond rapidly to this treatment (usually within four to eight weeks).
Sulfasalazine is given in doses of 4 tablets twice a day. Use of sulfasalazine is not recommended in patients with sulfa allergies, people with intestinal or urinary obstructions and individuals suffering from porphyria, a metabolism disease. A doctor may require regular blood tests while a patient is on sulfasalazine to monitor cell counts and liver enzymes. Possible side effects include nausea, rash, headache, abdominal pain, vomiting, fever and dizziness.
Biologics, such as Enbrel, Humira and Remicade, are also considered DMARDs. They are highly selective agents that target specific internal events in the body that cause psoriasis and psoriatic arthritis.
It is important to work closely with your rheumatologist or other health care provider. Each case of psoriatic arthritis must be evaluated individually.