How to Treat Psoriatic Arthritis and Psoriasis at the Same Time

Managing either psoriatic arthritis (PsA) or psoriasis alone can be difficult, and when the two occur together — which is common — it’s even more challenging. The good news is that the right medication can help you manage conditions simultaneously.

Both PsA and psoriasis are autoimmune conditions wherein your immune system is overactive and mistakenly targets the body’s healthy cells. With psoriatic arthritis, the immune system attacks joints and connective tissue, causing them to become swollen and painful. Psoriasis develops when the immune system misfires and causes skin cells to grow too rapidly, accumulating in layers and forming itchy, discolored plaques.

Here, learn about the co-occurrence of the two conditions, medications poised to treat both at once, risks to consider, and tips for managing each issue.

People with psoriatic arthritis almost always have psoriasis first, saya Francis C. Luk, MD, a rheumatologist at Advent Health in Hendersonville, North Carolina. “There is a small percentage of people who will actually get the arthritis first, but that’s a minority of cases,” says Luk.

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.

If you have psoriasis and psoriatic arthritis, you need an individualized treatment plan based on the severity of each condition and your response to medication. According to Luk, there are a number of different drug options that you and your doctor can consider, depending on what’s right for your specific needs:

• Nonbiologic Disease-Modifying Antirheumatic Drugs (DMARDs) Cyclosporine (Restasis), leflunomide (Arava), methotrexate (Trexall), and sulfasalazine (Azulfidine) 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 risankizumab-rzaa (Skyrizi), an IL-23 inhibitor; guselkumab (Tremfya), also an IL-23 inhibitor; ustekinumab (Stelara), an IL-12 and IL-23 inhibitor; and secukinumab (Cosyntyx), an IL-17 inhibitor.
• JAK Inhibitors Xeljanz, Xeljanz XR (tofacitinib), and upadacitinib (Rinvoq) are among the JAK inhibitors that can reduce inflammation from psoriatic arthritis by targeting a specific part of the immune system.
• Selective Tyrosine Kinase 2 (TYK2) Inhibitors Deucravacitinib (Sotyktu) is a once-daily oral TYK2 medication, which is a class of medication that treats certain inflammatory skin conditions.

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   It has U.S. Food and Drug Administration (FDA) approval to treat PsA and plaque psoriasis.

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• Phosphodiesterase Inhibitors Otezla (apremilast) blocks the action of certain naturally occurring substances in the body that cause inflammation.
• GLP-1 Receptor Agonists Emerging research shows promise for certain GLP-1s to treat various forms of psoriatic disease, including PsA.

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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 ibuprofen (Advil or Motrin) and aspirin can ease psoriatic arthritis pain, but they won’t improve psoriasis.

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.

The following advice from doctors 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 each doctor has the contact information for the other and request that they communicate. Try to be aware of the possible side effects of the drugs you’re taking, and if you’re concerned you’re experiencing a side effect or negative reaction, speak with the appropriate doctor at the first sign of trouble.

Stick to your treatment plan. Be sure to take all medication as directed, and don’t discontinue any without talking with your doctor first, says Luk. If cost is an issue, check the drug manufacturer’s website for financial assistance options or ask your doctor if there’s a less expensive treatment you could try.

Speak with your pharmacist. Your pharmacist is a good resource if you have questions about medications, possible interactions, or would like more information about drug affordability programs.

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.

• Psoriasis and psoriatic arthritis (PsA) are two separate chronic autoimmune conditions, but it’s common to experience both. An estimated 30 percent of people who have psoriasis will develop PsA.
• It’s possible to treat both conditions with one medication. Several different types of medications are available to appropriately treat both psoriasis and PsA, depending on the specifics of your presentation for both conditions.
• The approach of treating PsA and psoriasis with a single medical treatment isn’t right for all people and isn’t without risks. Effectively treating the conditions this way requires close medical monitoring and ongoing communication with your provider.

Additional reporting by Becky Upham.