Management for peripheral psoriatic arthritis
When starting therapy for psoriatic arthritis consider the potential impact of a new drug on the person’s underlying psoriatic skin disease, as well as the effects of the therapy used to manage psoriatic skin disease on the person’s arthritis. Whenever possible, an immunomodulatory drug that is effective for both indications should be used, to avoid polypharmacy. For guidance on the management of psoriasis (including primary care treatment and considerations such as psychological health), see Psoriasis.
Peripheral psoriatic arthritis can be destructive; ensure good disease control, even in people with only 1 or 2 joints involved.
In addition to nonpharmacological management, as recommended for axial spondyloarthritis (see Management of axial spondyloarthritis), the following drug therapies may be used as part of a multidimensional approach:
- in monoarticular disease, nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular corticosteroid injections are often used first line; disease-modifying antirheumatic drugs (DMARDs) are used for resistant or progressive cases
- in oligoarticular and polyarticular disease, DMARD therapy is required. For more information, see conventional synthetic DMARDs and biological and targeted-synthetic DMARDs for peripheral psoriatic arthritis.
As psoriatic arthritis is associated with an increased risk of cardiovascular disease, advise people about lifestyle modification, and monitor and actively manage risk factors for cardiovascular disease (see Atherosclerotic cardiovascular disease risk estimation).Agca, 2017Ogdie, 2015