Although there is no cure for PsA, most patients have their disease under control and lead meaningful lives. Sustained and increasing research is necessary. Specialised and dedicated PsA clinics may result in better outcomes. Some patients may require the care from different specialties including rheumatology, dermatology, gastroenterology and ophthalmology to manage manifestations in bone / joint, skin, inflammation of bowel, and inflammation of eyes.
Currently, there are various good drug treatments that can reduce joint swelling and pain, slow down joint damage and preserve function. Some drugs can control both skin and joint disease.
a) NSAIDs (non-steroidal anti-inflammatory drugs) like diclofenac acid or COX-2 inhibitors are helpful in reducing pain and stiffness. Reducing pain is important as it makes you more comfortable. However, these drugs will only reduce the symptoms and do not slow down the progression of the disorder.
b) DMARDs (disease modifying anti-rheumatic drugs) are needed for majority of patients. They reduce swelling and inflammation and slow down joint damage. These include methotrexate, sulphasalazine, leflunomide and cyclosporine. Steroids can also be injected directly to a joint to relief pain and swelling. However, oral steroids should be avoided because of significant side-effects. Stopping steroids suddenly may also trigger a flare in psoriasis skin lesions. Your doctor is the best judge on which drugs to use.
c) There is now two groups of drugs call biological (-b) DMARDs and (-ts) targeted synthetic DMARDs, which can control the disease quickly and greatly slow down joint damage. bDMARDs are given as injections, while tsDMARDs are drug given orally. They control the inflammation by blocking specific pathways in the immune system rather than blocking it generally in the case of traditional DMARDs. They are very effective in controlling both arthritis and skin disease and have improved the quality of life and prognosis of many patients since early 2000. 30-50% of patients may need these treatments in long term. Your doctor is the best judge on which drugs to use.
Once the inflammation is under control and you have less pain, it is important to rebuild the muscle and ligaments weakened by the arthritis. Exercise rebuilds muscle strength which can aid to stabilise the joints. Apart from strengthening the muscles, exercise also help you to reduce weight, or maintain weight. Body fat and obesity trigger more inflammation in the body and will worsen both your skin and arthritis. A healthy diet is obviously as important in weight control.
While some sports may stress the joints excessively and are not suitable, most gentle exercises like jogging, walking, swimming are good to keep you strong. It is important not to exercise the acutely swollen and painful joints. Your physiotherapist is the best person to ask for advice.
Sometimes surgery is necessary to correct joint deformities or to replace a completely destroyed joint.
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