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Treating Severe PsA: Doctor Discussion Guide

By EmpowHER
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man with psa talking to his doctor

Understanding PsA

Psoriatic arthritis (PsA) is a chronic inflammatory form of arthritis. It develops in the major joints of some people with psoriasis. In fact, up to 30 percent of people with psoriasis develop PsA.

Early diagnosis of PsA can prevent joint problems from starting. Early diagnosis also helps doctors prescribe the right treatment. PsA requires a different treatment approach than psoriasis alone does.

PsA can be classified from mild to severe. Mild PsA affects four or fewer joints. Severe PsA affects five or more joints and is also known as polyarticular psoriatic arthritis. If you have severe PsA, you need to see a rheumatologist. This is a doctor who specializes in rheumatic diseases.

The following are some questions to bring up to your doctor during your next visit.

What do my laboratory, screening, or imaging tests mean?

To be diagnosed with PsA, you'll need to have a series of tests done.

Laboratory tests that show high acute-phase ]]>C-reactive protein]]> (CRP) and ]]>erythrocyte sedimentation rate]]> (ESR) indicate PsA. High levels of CRP and erythrocytes in your blood can mean you have acute inflammation. According to a review in the British Journal of Dermatology, 50 percent of people with PsA have elevated ESRs and CRP levels.

Your doctor may also ask you to fill out a questionnaire. Doctors use certain questionnaires as screening tools for PsA. Your answers can help your doctor decide if you need further testing to check for PsA. Examples of these questionnaires include:

  • Psoriatic Arthritis Screening and Evaluation
  • Toronto Psoriatic Arthritis Screening
  • Psoriatic Epidemiology Screening Tool

To verify a PsA diagnosis, doctors will usually perform imaging tests. These tests can also rule out similar health conditions, such as rheumatic arthritis. Common imaging tests for PsA include X-rays, ultrasound, and magnetic resonance imaging (MRI).

Your doctor may also look at your skin and nails. This is because skin and nail symptoms can also be signs of PsA.

How can I prevent or reduce joint damage and disability?

If you have PsA, you're likely to also have progressive joint damage and disability. You may not be able to prevent joint damage completely. However, your doctor can suggest techniques and drugs that can help.

For example, your doctor may suggest exercises. Exercise can help ease your symptoms, maintain a healthy weight, and remove stress from your joints. Ask your doctor what exercise is best for you.

When can I start treatment?

The earlier you start treatment for PsA, the better. One study found that starting treatment within two years of the onset of symptoms reduced how much the illness progressed.

What medications are best to treat my PsA?

Your treatment approach with drugs will depend on how severe your PsA is. Talk about the following treatment options with your doctor.

Synthetic disease-modifying antirheumatic drugs (DMARDs)

DMARDs are used to treat moderate to severe PsA. DMARDs used in the treatment of PsA include:

  • methotrexate
  • sulfasalazine
  • leflunomide
  • cyclosporine A

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are used for treating mild PsA. NSAIDs are available both as over-the-counter (OTC) drugs and as prescription drugs. Examples of OTC NSAIDs include aspirin, ibuprofen, and naproxen. An example of a prescription NSAID is celecoxib (Celebrex).

Glucocorticoids (corticosteroids)

Glucocorticoid drugs can be injected through a vein or directly into the affected joints. Oral forms should not be used for PsA. This is because they might increase the chance of raised bumps filled with pus (called psoriatic pustules) on your skin. Doctors are often cautious about prescribing corticosteroids because they can cause flare-ups. However, corticosteroids work well to relieve inflamed or swollen joints.


According to a review published in The Annals of the Rheumatic Diseases, biologic drugs that target the tumor necrosis factor (TNF) involved in psoriasis can control symptoms of PsA. Biologics are helpful when NSAIDs and DMARDs don't work. TNF-inhibitor biologics used to treat PsA include:

  • etanercept (Enbrel)
  • adalimumab (Humira)
  • infliximab (Remicade)
  • golimumab (Simponi)
  • certolizumab pegol (Cimzia)

Another biologic, ustekinumab (Stelara), is not a TNF inhibitor. However, it's used for people with moderate to severe psoriasis who are also candidates for phototherapy or systemic therapy.

If other drugs are not working for you, ask your doctor if biologics are the answer.


Apremilast (Otezla) is a new oral drug used to treat PsA. If other drugs aren't working for you, your doctor may consider this medication.

The takeaway

Showing up prepared for your doctor visit is one of the best, and easiest, ways to find the treatment that's right for you. Here are some steps you can take to make the most of your visit:

  • Keep a running list of your questions before you get there.
  • Jot down all of your symptoms.
  • If your doctor suggests a medication, ask how well it usually works to treat PsA.
  • Ask your doctor about any side effects the drug may cause.
  • Share any concerns with your doctor.

You and your doctor can work together to create a plan to manage your PsA effectively.

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