Psoriatic Arthritis (cont.)
Disease-Modifying Medicines
Patients who experience progressive joint destruction in spite of NSAIDs
are candidates for more aggressive disease-modifying medications. Disease modifying medications are important to
prevent progressive joint destruction and deformity. These
medications include methotrexate, which is used orally or can be given by injection on
a weekly basis for psoriatic arthritis as well as for psoriasis alone. It
can cause bone-marrow suppression, as well as liver damage with long-term use. Regular monitoring of blood counts and liver blood tests should
be performed during therapy with methotrexate.
Antimalarial medication such as hydroxychloroquine (Plaquenil) is also
used for persistent psoriatic arthritis. Its potential side effects
include injury to the retina of the eye. Regular ophthalmologist
examinations are suggested while using this medication.
Injectable gold (Solganol) and oral gold auranofin
(Ridaura) have potential
side effects including bone-marrow suppression which can lead to anemia
and low white blood counts and adverse effects on the kidney, causing
loss of protein or blood in the urine.
Sulfasalazine (Azulfidine) is an oral sulfa-related medicine that has
also been helpful in some patients with persistent psoriatic arthritis.
Traditionally, Azulfidine has been an important agent in the treatment of
ulcerative and Crohn's colitis. It should be taken with food, as it too
can cause gastrointestinal upset.
Research has demonstrated effective
treatment of both psoriasis and psoriatic arthritis with leflunomide
(Arava), a medication that was approved in 1998 for the treatment of
rheumatoid arthritis.
The TNF-blockers etanercept (Enbrel), infliximab (Remicade),
and adalimumab (Humira) can be very
effective for severe psoriatic arthritis and they can significantly improve or eradicate both the psoriasis and the arthritis as well as stop progressive joint damage.
Corticosteroids are potent anti-inflammatory agents. Corticosteroids can
be given by mouth (such as prednisone) or injected (cortisone) directly
into the joints to reduce inflammation. They can have side effects,
especially with long-term use. These include thinning of the skin, easy
bruising, infections, diabetes, osteoporosis and, rarely, bone death
(necrosis) of the hips and knees.
While the relationship between the skin disease and joint disease is not
clear, there are reports of improvement of the arthritis simultaneously
with clearing of the psoriasis. Patients with psoriasis can benefit by
direct sunlight exposure and are often treated with direct ultraviolet
light therapy.
Finally, patients who have severe destruction of the joints may be
candidates for orthopedic surgical repair. Total hip joint replacement and
total knee joint replacement surgery are now commonplace in community
hospitals throughout the United States.
Next: What does the future hold for patients with psoriatic arthritis? »
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From the Doctors at MedicineNet.com  |
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- Cortisone Injection - Read about cortisone injection treatment for inflammation, allergic reaction, sciatica and arthritis. Learn about side effects and complications of a cortisone shot. Source:MedicineNet
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