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Treatment for psoriatic arthritis depends on the severity of the condition. Basically management requires treatment for arthritis as well as psoriasis. Treatment generally involves a combination of exercise and medication.

Patient education is another aspect of management which is important as understanding of the condition ensures better compliance to treatment and therefore control of psoriatic arthritis.

Conditions that have been reported as accompanying a worsening of psoriatic arthritis include infections, stress, and changes in season and climate. Certain medicines such as beta blockers (a type of antihypertensive drug) have been reported to trigger or aggravate psoriasis.

Exercise is an important component of treatment. Low-impact exercises such as brisk walking, stretching, swimming and line dancing will increase mobility and reduce morning stiffness in joints. It also helps maintain a healthy weight, so as to reduce stress on joints, especially at the knees.

Keeping mobile will also help decrease pain, as exercise will strengthen the muscles surrounding the joint to support its movement as well as improve its range of motion.

Skin care is also key to good management of psoriatic arthritis. Keeping the skin soft and moist is helpful such as applying moisturisers after bathing. Topical creams or moisturisers, such as Vitamin D or steroid cream, help to keep skin moisturised and prevent drying, flaking and itching.

Some psoriatic patients may need PUVA (psoralen plus long-wave ultraviolet A light) therapy, which slows cell growth and keeps psoriasis in check. This is a combination of a prescription medicine psoralen, taken either in tablet form or added to a bath, plus exposure to type A ultraviolet light. Therapy usually consists of 20 to 30 treatments over several weeks, under strict medical supervision.

Avoid carrying heavy things or undertake activities which may cause a strain to the affected joints. If the wrist and fingers joints are affected with arthritis, it may be beneficial to wear a splint at night or a working splint during the day for joint support.

People who have psoriatic arthritis can still have a good quality life. What matters more is having the knowledge to tackle social misconceptions about this condition. People must first know that psoriasis is not infectious.

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Psoriasis treatment options are extensive and include emollients, salicyclic acid, coal tar, anthralin, corticosteroids, calcipotriol, tazarotene, methotrexate, retinoids, immunosuppressants, immunotherapeutic agents and light therapy. These treatment can be divided into topical and systemic treatment for psoriasis.

Topical Treatments

Topical treatment include the usage of emollient creams, ointments, petrolatum, paraffin and hydrogenated vegetable oils. They reduce scaling and are most effective when applied immediately after bathing. Lesions may appear redder as scaling decreases or becomes more transparent. Emollients are safe and should always be used for mild to moderate plaque psoriasis.

Emolient Cream

Salicylic acid is a keratinolytic that softens scales, facilitates their removal, and increases absorption of other topical agents. It is especially useful as a component of scalp treatments.

Salicylic Acid

Coar tar ointments, solutions, or shampoos are anti-inflammatory and decrease keratinocyte hyperproliferation through an unknown effect. They are typically applied at night and washed off in the morning. They can be used in combination with topical corticosteroids or with exposure to natural or artificial ultraviolet (UV) B light (280 to 320 nm) in slowly increasing increaments.

Corticosteroids are usually used topically but may be injected into small or recalcitrant lesions. 

Warning: systemic corticosteroids may precipitate exacerbrations or development of pustular psoriasis and should not be used for any form of psoriasis therefore it is not adviseble to take corticosteroids orally. 

Topical corticosteroids are used sometimes with anthralin or coal tar which are applied before retire for the night. Corticosteroids are most effective when used overnight under covering or tape.

Calcipotriol is a topical vitamin D3 analogue that induces normal keratinocyte proliferation and differentiation; it can be used in combination with topical corticosteroids.

Tazarotene is a tropical retinoid but less effective than corticosteroids as a monotherapy.

UV light therapy (phototherapy) is typically used in patients with extensive psoriasis. UVB light reduces DNA synthesis. In pasoralen-ultraviolet light therapy (PUVA), oral methoxypsoralen, a photosensitizer, is followed by exposure to long-wave UVA light (330 to 360 nm). PUVA has a antiproliferative effect and also helps to normalize keratinocyte differentation. Dosses of light are started low and advanced as tolerated. Severe burns can result if the dose of drug or UVA is too high. Although the treatement is less messy than topical treatment and may produce remissions lasting several months, repeated treatments may increase the incidence of UV-induced skin cancer.

PUVA

Systemic Treatments

Methotrexate taken orally is the most effective treatment in severe disabling psoriasis, especially severe psoriatic arthritis or widespread erythrodermic or pustular psoriasis that are unresponsive to topical agent. Methotrexate interfere with the rapid proliferation of epidermal cells. 

Systemic retinoids (acitretin, isotretinoin) may be effective for severe and recalcitrant cases of psoriasis vulgaris, pustular psoriasis (preferred use is isotretinion), and hyperkeratotic palmoplantar psoriasis. Because of the teratogenic potential and long-term retention of acitretin in the body, women must not be pregnant and should be warned agains becoming pregnant for at least 2 years after treatment ends.

Cyclosporine is an immunosuppressant that can be used for severe psoriasis but should be limited to courses of several months and rarely up to 1 year. Its affect on the kidneys and potential long-term effects on the immune system therefore it is recommended to use cyclosporine liberally.

The choice of conventional treatment is based on the severity of the psoriasis patients and the inclination of the medical practinioner. However as most of these conventional methods do not results in long term remissions, many patients have explored other non-conventional methods (which are explain in different part of this website).

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