Psoriatic Arthritis (PsA)
Psoriatic Arthritis (PsA)
www.spondylitis.org
info@spondylitis.org
MEDICATION
Overview
There are a number of different types of medications that have been found to be effective in managing the symptoms of psoriatic arthritis. Unlike other forms of spondylitis, psoriatic arthritis may require the attention of a dermatologist as well. A dermatologist may prescribe medications to help treat the skin condition that is caused by the disease. For more information on the medications used in treating the psoriasis that occurs with psoriatic arthritis, please click here.
NOTE: Different people respond to different medications with varying levels of effectiveness. Thus, certain medications may work as well, depending on the individual. It may take time to find the most effective medication for treating someone with PsA.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDs are the most commonly used class of medication used in treating the pain and stiffness associated with PsA. For example, Ibuprofen is a generic NSAID and is found in over-the-counter pain relievers such as Advil and Motrin. They commonly come in tablet form and are taken orally.
Sometimes high doses of NSAIDs are needed to maintain relief from the symptoms of PsA. This can pose a problem in that NSAIDs can cause significant side effects, especially in the gastrointestinal tract (stomach, intestines, etc.) NSAIDs can cause reduction in the protective mucus in the stomach, which can cause stomach irritation. In time, this can lead to heartburn, gastritis as well as ulcers and even bleeding. People can take other medications to neutralize or prevent the production of excess stomach acid to help prevent these side effects (such as antacids), take drugs to help coat and protect the stomach (such as Carafate), or take medication to help restore the lost mucus (such as Cytotec).
A newer class of NSAIDs known as COX-2 inhibitors (or COXIBs) allegedly reduce the risk of gastrointestinal complications associated with traditional NSAID therapy. However, in recent months two of the COX-2 inhibitors have been found to have their own potential, serious side effects. One of the more regularly prescribed COX-2s, Vioxx (Rofeocoxib), was pulled from the worldwide market because of the possible increased risk of heart attack when taking the medication. Another COX-2, Bextra, was also pulled from the market in April of 2005.
Other less common side effects from NSAIDs include headaches, dizziness, fluid retention and even confusion.
Below are the names of the more commonly used NSAIDs in treating ankylosing spondylitis as well as links to more information on each drug.
IBUPROFEN (Generic NSAID)
Patient Information
ARTHROTEC (Diclofenac and Misoprostol)
Patient Information
NAPROSYN, ALEVE and Others (Naproxen)
Patient Information MOBIC (Meloxicam)
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INDOCIN (Indomethacin)
Patient Information VOLTAREN (Diclofenac)
Patient Information
CELEBREX (Celecoxib)
Patient Infromation
When NSAIDs Are Not Enough?
Although NSAIDs are commonly the first line of medications used to treat psoriatic arthritis, sometimes they aren't enough to control the symptoms. It is important to note, however, that it may take several weeks for some NSAIDs to show positive results. If you are considering changing medications, remember to ask your doctor about the potential benefits and side effects before you and your doctor decided whether the change in treatment is right for you.
In severe cases of PsA, NSAIDs may only be partially effective or the side effects to severe to continue their use. In this case, a doctor may prescribe one of the following medications.
Stay Informed!
Stay up-to-date on all the latest news and information regarding AS and related diseases including medications with our news magazine, Spondylitis Plus. Your subscription comes free with SAA membership.
Sulfasalazine
Sulfasalazine is one type of medication that can be helpful to some people with severe disease. It is known to effectively control not only pain and joint swelling from arthritis of the small joints, but also the intestinal lesions in inflammatory bowel disease. It comes in tablet form and is taken orally.
Side effects are relatively infrequent, but can include headaches, abdominal bloating, nausea and oral ulcers. Rarely, someone being prescribed this medication can develop bone marrow suppression, which is why it is important for your doctor to regularly monitor your blood count.
AZULFIDINE (Sulfasalazine)
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Methotrexate
Originally developed to treat cancer, this chemotherapy drug is widely used and often very effective for the treatment of rheumatoid arthritis. When prescribed for treating psoriatic arthritis, it is given in much smaller doses. Methotrexate can either be taken via a self-injectable shot, or orally in tablet form. When taking methotrexate, it is also necessary to take the vitamin folic acid in order to help suppress possible side effects.
Oral ulcers and nausea are the most common side effects, but can be minimized by taking folic acid. Because of other potential serious side effects, the frequent monitoring of blood counts and liver tests are required. Click here for an article on methotrexate in the treatment of PsA, or click the link below for more information on the drug.
RHEUMATREX (Methotrexate)
Patient Information
Corticosteroids
Corticosteroids such as prednisone can be effective in relieving the inflammation of PsA, but the side effects of long-term use can be very severe. Corticosteroid injections into the inflamed joints can provide temporary relief of the pain caused by arthritis or bursitis. In instances of Achilles' tendonitis, such injections are rarely, if ever used because of the risk of rupturing the Achilles tendon. Also, the usefulness of corticosteroid injections to relieve the symptoms of plantar fasciitis (heal pain) is not clear. More information on corticosteroids can be found at Medline Plus.
The Biologics: TNF Inhibitors
This class of medications has shown great promise in treating ankylosing spondylitis and are sometimes prescribed off-label for PsA - specifically incases of severe disease. They have been shown to be highly effective in treating not only the arthritis of the joints but also the spinal arthritis. Click here for more information in our Ongoing Special Report: The Biologics, TNF Inhibitors.
The most serious side effect of TNF blockers is an increased frequency of infections, especially tuberculosis. Thus, a TB test is ususally required before starting any of the TNF therapies. A very rare possible complication is increased frequency of cancer, especially of the blood (leukemia) or of the lymphatic system (lymphoma).
Note that not everyone with psoriatic arthritis will need these medications. You and your doctor can decide which of these medications, if any, would be best for you.
ENBREL (Etanercept)
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REMICADE (Infliximab)
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Humira (Adalimumab)
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Click here for more information in our Ongoing Special Report: The Biologics, TNF Inhibitors.
Note that not everyone with PsA will need these medications. You and your doctor can decide which of these medications, if any, would be best for you.
Contact Information
Address:
Spondylitis Association of America
PO Box 5872
Sherman Oaks, CA 91413
Toll-free Phone Number (U.S. Only): 1-800-777-8189
Phone: 1-818-981-1616
Email: info@spondylitis.org
Headquarters:
Spondylitis Association of America
14827 Ventura Blvd. #222
Sherman Oaks, CA 91403
About Spondylitis
In this section you can read about the diseases that are classified as Spondylitis. The following pages contain general information on each of the diseases including symptoms, diagnosis, treatment, medications and links to additional online resources:
Ankylosing Spondylitis (AS)
Undifferentiated Spondyloarthropathy (USpA)
Juvenile Spondyloarthropathy (JSpA)
Psoriatic Arthritis (PsA)
Reactive Arthritis (ReA)
Enteropathic Arthritis
An Overview of Spondylitis
Spondylitis (pronounced spon-d-lie-tiss) is the name given to a group of chronic or long lasting diseases also called Spondyloarthritis (spon-dyl-oh-arthritis) or Spondyloarthropathy (spon-d-low-are-throp-ah-thee). These diseases are forms of inflammatory arthritis that primarily affect the spine, although other joints and organs can become involved. Spondylitis, unlike many other rheumatic (arthritic) conditions, affects young adults and commonly begins before the age of 35. Prominent researchers have stated that AS affects at least 1 in every 200 adults (approximately 0.5%) making it as common as rheumatoid arthritis.
Although there is currently no known cure, there is much you can do to educate yourself regarding Spondylitis and its treatments. There have been significant advancements in medical treatments during recent years and there are treatment options for those afflicted that can reduce the pain and symptoms of Spondylitis.
If you, a family member or friend has been diagnosed with Ankylosing Spondylitis or related disease, you have come to the right place. The Spondylitis Association of America is here to help you learn as much as you can about these conditions and to provide you with additional support and information. Here you will also find a Frequently Asked Questions section, a section on possible Complications of Spondylitis, some Fast Facts on Ankylosing Spondylitis, the primary disease in the group of diseases that comprise spondylitis or spondyloarthropathies, as well as a Doctor Q&A section, Doctors Answer Questions About Ankylosing Spondylitis.
We also offer a wide range of Educational Materials, including books, brochures and more that contain valuable information on ankylosing spondylitis and related diseases.
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