Your Step-by-Step PsA Treatment Timeline
Psoriatic arthritis (PsA) treatment isn’t just about taking a medication, feeling better, and moving on. If only it could be that cut-and-dried! Like many other chronic conditions, it involves carefully evaluating your symptoms and therapy options, then trying something to see if it works. If it doesn't, it’s time to re-evaluate and change it up. If you’re newly diagnosed, it's hard to know what to expect during the treatment process. We asked experts to lay it all out so you can go into it feeling prepared.
PsA Treatment: Trial and Error
No one can know upfront which treatment will work for each person, says Ana-Maria Orbai, M.D., director of the psoriatic arthritis program at Johns Hopkins Arthritis Center in Baltimore. Doctors usually recommend first-line medications, depending on disease severity, and then try newer, more-expensive options when those don’t cut it. This is partially because health insurance won’t approve some medications unless a patient has failed others first, says Stanford Shoor, M.D., a rheumatologist at Stanford Health Care in Palo Alto, CA. Scientific evidence and precedent factor in, too. Your rheumatologist will likely use some version of the following steps to guide your treatment.
Step 1: Establish the Goal of Treatment
In addition to the obvious aims of slowing PsA progression and reducing pain to a level that allows you to put the disease in the background, many people have goals unique to their situation. For example, maybe you want to take a job that seems too challenging right now because of one specific symptom you can’t shake. Maybe you have other hopes outside of treatment, like getting pregnant, that will impact the meds you can take over the next few years. Communicate your goals to your doctor upfront so you’re starting on the same page.
Step 2: Assess the Level of Disease
It’s important to continually re-evaluate the severity of disease, since it can change. Before picking or changing a treatment, your doctor will want to determine if your PsA is currently mild, moderate, or severe. They’ll ask: “How active do you think your PsA has been in the recent past?” to gauge the severity, Dr. Shoor says. They’ll also do a physical exam, counting the number of tender or swollen joints. Other symptoms like severe swelling of an entire digit (called dactylitis) or severe tendonitis can also indicate more severe disease, Dr. Shoor says.
Step 3: Discuss Your Options
The most important thing to know: “You have options,” Dr. Shoor says. There are many different PsA medications that can be used to treat the disease depending on severity. Each type of medication works in the body in a different way, so if one doesn’t end up doing much for you, your doctor can prescribe something else that might be a better fit. The main types of medications used in PsA treatment are nonsteroidal anti-inflammatories (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), biologics, and new oral medications. Corticosteroids may be used short-term to treat bad flares.
Step 4: Consider Other Health Issues at Play
Another important factor to take into account is whether a certain treatment is safe and recommended to take with any other health conditions you have. Certain medications are not OK for certain comorbidities—for example, a few biologic drugs may exacerbate irritable bowel disease (IBD). Others may require special monitoring. While other aspects of your health may seem unimportant when you’re trying to get PsA treatment sorted out, it’s really important to get a full picture of your health and work with your doctor to make sure any new treatments are safe, all things considered.
Step 5: Add in Lifestyle Modifications
Never underestimate the impact your daily health choices can have, especially when paired with medication. Dr. Shoor says that after discussing treatment options with patients, he then discusses what they can do on their own in tandem. Most people with a chronic condition want to do whatever they can to improve their condition and quality of life, and making changes in diet, exercise, and stress management can help make a difference. Other remedies like hot baths, wax therapy, and massage may also help you find some relief.
Step 6: Check on How It’s Working
If treatment is working, you should see an improvement in symptoms in three months, Dr. Orbai says. Yes, that long. The reason is that by the time PsA is symptomatic and diagnosed, the immune system is revved up significantly, so it takes some time for the drugs to catch up, she explains. “If there’s no improvement at about three months, that means it’s probably not a good match for you.” At that time, you and your doctor will go back to the drawing board and try something different to see if you respond to it better.
Step 7: Weigh the Pros and Cons
If a medication is improving your PsA, it’s important to also consider the cost. Does it cause intolerable side effects? Do you have a hard time taking it as prescribed because of the frequency or form (self-injection, for example)? Is it draining your bank account? These are all good reasons to talk with your doctor. Also, some medications can quietly impact other aspects of your health, like liver enzyme levels. An important function of your rheumatologist visits is to make sure your treatment isn’t only working, but that it’s also not causing you any harm, Dr. Orbai says.
Step 8: Keep Evaluating and Reassessing
Managing PsA is a lifelong process. Treatment needs to constantly be evaluated because side effects and efficacy can change. A biologic, for example, is usually only effective for a few years, Dr. Orbai says. “It is rare that a biologic is going to be effective forever.” One possible reason is that a person can develop antibodies against the drug. Staying in tune with how you feel and having an open line of communication with your doctor is the best way to make your treatment do as much for you as possible.