Psoriasis develops when the immune system misfires and causes skin cells to grow too rapidly, accumulating in layers and forming itchy, discolored plaques. With psoriatic arthritis, the immune system attacks joints and connective tissue, causing them to become swollen and painful.
Psoriatic Arthritis and Psoriasis: Which Comes First?
People with psoriatic arthritis almost always have psoriasis first, says Francis C. Luk, MD, a rheumatologist at Wake Forest Baptist Health in Winston-Salem, North Carolina. “There is a small percentage of people who will actually get the arthritis first, but that’s a minority of cases,” says Dr. Luk. It’s estimated that about 30 percent of people with psoriasis go on to develop psoriatic arthritis, according to the National Psoriasis Foundation. The first signs of arthritis are often swelling and pain in the hands, but the disease can cause early symptoms in other parts of the body too. “Feet, knees, or ankles — pretty much any joint can be involved in the arthritis,” Luk says. Symptoms of psoriasis and psoriatic arthritis can flare or subside at different times, according to the American College of Rheumatology. Either condition can be mild, moderate, or severe; for instance, you can have severe psoriasis and mild psoriatic arthritis, or vice versa. The disorders might target the same or different parts of the body — you could have psoriasis lesions on your elbows, say, but no pain in your elbow joints. When the two conditions flare at the same time, one may be worse than the other, according to an overview published in the American Journal of Managed Care. Aggressively treating psoriatic arthritis as soon as joint symptoms develop is vital, because the disease can cause permanent damage. “There can be erosion of the bones, usually near the joint spaces. When those erosions form it can lead to decreased motion in that joint,” Luk says. “For example, if the arthritis is in the wrist, you could lose your ability to move your wrist back and forth. If it’s in your fingers, you could lose your ability to grip.” Once damage sets in, there’s not much you can do to reverse it, he adds.
Nonbiologic Disease-Modifying Anti-Rheumatic Drugs (DMARDs) Restasis (cyclosporine), Arava (leflunomide), Trexall (methotrexate), and Azulfidine (sulfasalazine) can be used to suppress the immune system and slow down the processes that result in psoriatic arthritis and psoriasis. If the psoriatic arthritis is severe, your doctor may prescribe two DMARDs.Biologic DMARDs These drugs made from living cells treat psoriasis and psoriatic arthritis by targeting key parts of the immune system involved in the inflammation process, such as the protein tumor necrosis factor alpha (TNF-alpha), and interleukins 12 and 23. These medications include Stelara (ustekinumab), an IL-12 and IL-23 inhibitor, and Cosyntyx (secukinumab), an IL-17 inhibitor.JAK Inhibitors Xeljanz and Xeljanz XR (tofacitinib) can reduce inflammation from psoriatic arthritis by targeting a specific part of the immune system. Although JAK inhibitors have shown some success as a treatment for psoriasis in studies, they are not approved by the U.S. Food and Drug Administration (FDA) for this use.Phosphodiesterase Inhibitors Otezla (apremilast) blocks the action of certain naturally occurring substances in the body that cause inflammation.
Other medications focus on just one condition or the other. For example, topical therapies can treat psoriasis, but they won’t help your joints. Nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil or Motrin (ibuprofen) and aspirin, can ease psoriatic arthritis pain, but they won’t improve psoriasis.
Cautions About Medication
Treatment for psoriatic arthritis and psoriasis is often a balancing act because a drug that’s prescribed to calm one condition can lead to a flare of the other. For instance, NSAIDs may potentially make psoriasis appear worse as they ease psoriatic arthritis joint pain, according to a paper published in The Journal of Clinical and Aesthetic Dermatology. An injection of steroids can treat a psoriatic arthritis flare but stopping the drug can cause psoriasis to flare. Before deciding on a treatment plan, be sure to tell your doctor if you’re taking prescription medication for any other conditions, such as high blood pressure, high cholesterol, or diabetes, as well as if you use any over-the-counter medication or herbal remedies. Drug interactions can be a concern with some medications used to treat psoriasis and psoriatic arthritis, and some of the medications may have bothersome side effects. DMARDs may increase your risk for getting certain infections and certain cancers, according to Michigan Medicine.
Balancing Dual Treatments
These tips can help you manage both psoriatic arthritis and psoriasis: Get educated. The more you know about these disorders and their possible treatments, the better you can manage your symptoms. If you have any questions, ask your doctor. If you see a different doctor for each condition, be sure they communicate with each other. Know all possible side effects of the drugs you’re taking and alert the appropriate doctor at the first sign of trouble. Stick to your treatment plan. Be sure to always take all medication as directed and don’t discontinue any without talking with your doctor first, says Luk. If cost is an issue, check out the drug manufacturer’s website for financial assistance options, or ask your doctor if there’s a less expensive treatment you could try. Check in with your doctors. Know the time frame in which you should see some results after starting a new medication, and call your doctor if treatment isn’t helping, or is calming one condition but causing the other to flare. Many medications may take months to work, while biologic DMARDs may take just a few weeks to start making a difference, according to the Cleveland Clinic. There are many treatment options for both psoriatic arthritis and psoriasis, but it may take some trial and error to find the ones that work best for you. Additional reporting by Becky Upham.
