How to treat psoriatic arthritis

Psoriatic arthritis is also known as psoriatic arthritis, which is a type of arthritis that is closely related to psoriasis. After suffering from psoriatic arthritis, in addition to symptoms such as swelling, tenderness, stiffness and movement disorders, the biggest feature is the appearance of psoriasis rash. The incidence rate begins to increase after the age of 30, which has a great impact on the patient's health. So, how to treat psoriatic arthritis?

Psoriatic arthritis is also known as psoriatic arthritis. After the disease occurs, a rash will first appear on the joints, and then the soft tissues around the joints will have pain, stiffness, movement disorders and other symptoms. Psoriatic arthritis is hereditary. After being diagnosed with the disease, it is best to actively seek treatment, control the disease as much as possible, and prevent psoriatic arthritis from occurring again in offspring. So, how to treat psoriatic arthritis? Let’s take a look at the method below.

The purpose of treatment of this disease is to relieve pain, delay joint destruction and control skin damage. Treatment plans are tailored to each individual.

1. General treatment

Get adequate rest, avoid excessive fatigue and joint injuries, pay attention to joint function exercises, and avoid smoking, drinking and spicy food.

2. Medication

Drug selection is similar to that for rheumatoid arthritis, except for antimalarial drugs, which are still controversial.

(1) Non-steroidal anti-inflammatory drugs (NSAIDs) are suitable for patients with mild to moderate active arthritis. They have anti-inflammatory, analgesic, antipyretic and detumescent effects, but are ineffective against skin lesions and joint damage. The treatment dose should be individualized, and only when one NSAID is used at full doses for 1 to 2 weeks without any effect should it be switched to another. Avoid taking two or more NSAIDs at the same time. Elderly people should choose NSAIDs with a short half-life. Patients with a history of ulcers should take selective COX-2 inhibitors to reduce gastrointestinal adverse reactions.

(2) Slow-acting antirheumatic drugs (DMARDs) prevent disease progression and delay the destruction of joint tissue. If a single DMARD is ineffective, a combination of drugs can be used, such as methotrexate as the basic drug and sulfasalazine. The following is a brief description of several commonly used DMARDs: ① Methotrexate is effective for both skin lesions and arthritis and can be used as the first choice drug. It can be taken orally, intramuscularly, and intravenously, once a week at the beginning. If there are no adverse reactions and the symptoms worsen, the dose can be gradually increased to once a week. After the condition is controlled, the dose can be gradually reduced to once a week for maintenance. Blood routine and liver function tests should be performed regularly during medication. ②Sulfasalazine is effective for peripheral arthritis. Starting from a small dose and gradually increasing the dose can help reduce adverse reactions. Usage: Start with a small dose daily, then increase the appropriate dose each week. If the effect is not obvious, increase to the maximum dose (need to follow the doctor's advice). Blood routine and liver function should be checked regularly during medication. ③ Take penicillamine orally in appropriate doses. After the oral effect is seen, it can be gradually reduced to a maintenance dose. Penicillamine has many adverse reactions. Long-term high-dose use can cause kidney damage (including proteinuria, hematuria, nephrotic syndrome) and bone marrow suppression. Most patients can recover if the drug is stopped in time. Blood, urine, liver and kidney function tests should be performed regularly during treatment. ④ Azathioprine is also effective for skin lesions. Start taking it at the usual daily dose and give a maintenance dose after it takes effect. Blood routine and liver function tests should be performed regularly during medication. ⑤ Cyclosporine: The US FDA has approved its use for the treatment of severe psoriasis, and it is effective for skin and joint psoriasis. The FDA considers it maintenance treatment for less than one year; longer-term use is contraindicated for psoriasis. The usual dosage starts at the maintenance dosage (as directed by your doctor). Routine blood tests, blood creatinine and blood pressure should be checked during medication. ⑥Leflunomide is used for moderate and severe patients.

(3) Etretinate belongs to the aromatic retinoid class. Take appropriate dose orally (as directed by your doctor). Gradually reduce the dosage after the condition improves, and the course of treatment is 4 to 8 weeks. It is forbidden for women with abnormal liver and kidney function and high blood lipids, and for pregnant and lactating women. Because of the drug's potential teratogenicity and long-term retention in the body, patients should not become pregnant while taking the drug and for at least one year after stopping it. Pay attention to liver function and blood lipids during medication. Long-term use can cause calcification of spinal ligaments, so it should be avoided in patients with axial lesions.

(4) Glucocorticoids are used for patients with severe conditions that cannot be controlled by general drug treatment. Due to the many adverse reactions, sudden discontinuation of use can induce severe types of psoriasis and recurrence of the disease. Therefore, it is generally not suitable for use, let alone long-term use. However, some scholars believe that low-dose glucocorticoids can relieve patients' symptoms and serve as a "bridge" before DMARDs take effect.

(5) Herbal medicine (Tripterygium wilfordii) Tripterygium wilfordii polyglycosides should be taken three times a day after meals (the dosage shall be as prescribed by the doctor).

(6) Local medication ① Intra-articular injection of long-acting corticosteroids can be considered in acute monoarticular or oligoarthritis, but it should not be used repeatedly and should not be used more than three times a year. At the same time, avoid skin lesions. Excessive joint punctures can not only easily lead to infection, but also cause steroid crystal arthritis. ② Different local medications for psoriasis lesions are used depending on the type of lesions, condition, etc. For example, topical corticosteroids are generally used for mild to moderate psoriasis. Improper use or abuse, especially in large doses, can cause skin sagging, thinning and atrophy. Tar preparations can easily stain clothing and have an odor, so they can usually be taken during sleep. Apart from skin irritation, there are few other adverse reactions.

Anthralin is effective for mild to moderate psoriasis, but its inconvenience and adverse reactions limit its widespread application. Topical vitamin D3 and calcipotriol are used to treat moderate psoriasis. They have certain side effects, but are pollution-free and odor-free. They are not recommended for use on facial and genital skin, pregnant women, and children. Salicylic acid preparations are often used in combination therapy with glucocorticoids, anthralin, or coal tar preparations to enhance the effects of these drugs.

Tazarotene (Tazorac) is a topical retinal or vitamin A derivative used to treat psoriasis. The most obvious adverse reaction is that it turns the skin bright red, which often causes people to mistakenly believe that the condition has worsened. It is generally not used in skin folds, such as the groin and around the eyes. Others include black distillate ointment, camptotheca tincture solution, etc.

3. Surgical treatment

Surgical treatment, such as arthroplasty, is used for patients who already have joint deformity and functional impairment.