Psoriasis doesn't only affect your skin. According to the National Psoriasis Foundation, about 30 percent of people with psoriasis also develop a painful joint condition called psoriatic arthritis. Just as your immune system attacks your skin to produce a scaly rash, it also can attack your joints, leaving them swollen and inflamed.
The pain of psoriatic arthritis is usually centered in the fingers and toes. You also might notice soreness in your wrists, knees, ankles, neck, and lower back. The pain gets worse when you're under stress or you have a flare-up of psoriasis. In between these flare-ups are pain-free periods called remissions.
Don't suffer through your pain. Psoriatic arthritis does more than just hurt. Over time it can damage your joints. If you don't get treated, you may lose the ability to use the affected joints. Make an appointment with your rheumatologist to talk about treatment options.
Here's a guide to help you manage psoriatic arthritis pain and stop joint damage in its tracks.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Your doctor might first recommend treating your psoriatic arthritis pain with ibuprofen (Motrin, Advil), or naproxen (Aleve). These drugs relieve pain and bring down swelling in the joints. You can buy some NSAIDs over the counter. Stronger versions of these drugs are available with a prescription.
Celecoxib (Celebrex) is another type of NSAID called a COX-2 inhibitor. It's only available by prescription. COX-2 inhibitors relieve pain and inflammation with less stomach damage than other NSAIDs, but they can still cause heart problems and other side effects.
This is a new class of drugs approved for psoriatic arthritis. Currently, apremilast (Otezla) is the only drug available that falls in this category.
Disease-modifying antirheumatic drugs (DMARDs)
DMARDs don't just relieve pain — they also slow down joint damage from psoriatic arthritis. You take these drugs by mouth, through an injection, or directly into a vein.
- leflunomide (Arava)
- cyclosporine (Neoral, Sandimmune)
- methotrexate (Rheumatrex, Trexall)
- sulfasalazine (Azulfidine)
DMARDs can take a few weeks to start working. Because they dampen the immune system response, they can lower your body's ability to fight infections.
Biologic drugs are a newer form of DMARD. They prevent certain substances in your blood from launching the immune response against your joints.
Biologics called TNF-alpha inhibitors target a protein called tumor necrosis factor-alpha, which leads to joint inflammation. TNF-alpha inhibitors include:
- adalimumab (Humira)
- certolizumab (Cimzia)
- etanercept (Enbrel)
- golimumab (Simponi)
- infliximab (Remicade)
Secukinmab (Cosentyx) is not a TNF inhibitor, but is an interleukin-17A inhibitor.
Other psoriatic arthritis drugs
If NSAIDs and DMARDs don't help with your pain, your doctor might suggest one or more of these medicines:
- antidepressants: Amitriptyline (Elavil, Endep), desipramine (Norpramin, Pertofrane), and imipramine (Tofranil, Norfranil) can relieve chronic pain from conditions like psoriatic arthritis.
- topical pain relievers: You can rub these creams, gels, and ointments on your skin over the painful joints. Capsaicin is one type of topical pain reliever that contains an active ingredient found in chili peppers. It works by decreasing pain signals.
- steroid medicines: These medicines are injected straight into the joint to bring down swelling and relieve pain.
Medicine is one way to relieve psoriatic arthritis pain. You can also try some non-drug therapies to ease your discomfort:
In this treatment, long, thin needles are inserted into the skin. The needles trigger the release of natural painkilling chemicals in the body. Acupuncture is considered to be safe and has few side effects.
When you hurt, often the last thing you want to do is work out. Yet exercise is one of the best things you can do for your joints. Staying fit keeps joints limber. It also helps you lose weight, which takes pressure off your joints. The best exercises for psoriatic arthritis are those that are gentle on joints, such as yoga, tai chi, and swimming. Working out in warm water can also help soothe joint soreness. Ask your doctor which exercises are best for you. The doctor might recommend that you see a physical therapist to help you start an exercise program. The physical therapist can teach you how to do each movement safely and correctly.
Heat and cold
Both heat and cold can help with pain, so choose which one works best for you. Applying a cold pack to your sore joints helps numb the pain. A heating pad will soothe tight muscles.
This practice helps you relax and focus on your breath to relieve stress. Less stress may mean less psoriatic arthritis pain.
Don't try to do too much. When you're in pain, take a break and rest to take the stress off your joints.
Wear a brace or splint to relieve pressure on sore joints.
Work with your doctor to find the best pain relief option for you. It might take some trial and error, but eventually you should find something that works. As a last resort if your joints are badly damaged, you may need surgery to fix or replace them.