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Psoriatic Arthritis

Prevention & Treatment

Monday, Aug. 27, 2007; 7:46 PM

Copyright Harvard Health Publications 2007

Prevention

Table of Contents

There is no way to prevent psoriatic arthritis.

Treatment

The main treatment is to take nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn). Corticosteroids such as prednisone, taken by mouth, are used only occasionally, because they may cause significant side effects when taken long-term and the psoriasis tends to flare up when the drug is stopped. Occasional injections of a steroid can help when joints are severely inflamed.

When the condition is more severe, drugs such as hydroxychloroquine (Plaquenil) or methotrexate (Folex, Rheumatrex) often relieve symptoms or reduce joint inflammation. However, it is uncertain whether they protect the joints from damage. Rare reports linking hydroxychloroquine to worsening psoriasis have led some doctors to avoid this medication.

Sulfasalazine (Azulfidine), an anti-inflammatory agent used to treat inflammatory bowel disease, helps some people with psoriatic arthritis. Another anti-inflammatory medication, cyclosporine (Neoral, Sandimmune), has been used recently with good results. However, this medicine can damage the kidneys, so it is usually used only for people who have not responded to other treatments. Newer, injectiable medicines, including adalimumab (Humira), Etanercept (Enbrel) and infliximab (Remicade), can be highly effective, but because they are only available by injection and are quite expensive, they are reserved for people with psoriatic arthritis that does not respond to other treatments.

When joints deteriorate despite aggressive medical therapy, your doctor may recommend surgery to reconstruct or replace the joint, especially if the pain is localized and intense and you have difficulty functioning.

Your doctor may recommend physical and occupational therapy to maintain muscle strength and the joint's range of motion. Splinting, a removable brace to immobilize an inflamed joint, may help reduce symptoms and inflammation. Exercise is important, especially for people with spondylitis because being active tends to reduce back symptoms.

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