People who have psoriasis may also develop psoriatic arthritis, which affects the joints, often leaving fingers and toes with a sausage-like appearance. The number of joints affected and degree of symptoms varies from few joints on one side of the body with milder symptoms, to more than five joints affected symmetrically with severe or even debilitating pain. No cure has been found for this autoimmune disease, but new treatments are helping people control their symptoms.
Tumor Necrosis Factor (TNF) Inhibitors
Among the more recent developments for treating psoriatic arthritis (PsA) are tumor necrosis factor (TNF) inhibitors. TNF is a type of molecule that affects skin cell growth. In some types of arthritis, including psoriatic arthritis, it is overproduced.
TNF or TNF-alpha inhibitors, are among the newer class of biologic drugs that target specific parts of the immune system, as opposed to systemic drugs that have a more generalized effect. These drugs, as the name implies, inhibit the production of TNF, and thus reduce the symptoms and slow the joint damage of psoriatic arthritis. Among the TNF inhibitors on the market are: Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab) and Simponi (golimumab). All of these medications are given intravenously or by injection. Some must be administered at a clinic, while others can be self-injected at home.
Ustekinumab
This biologic is similar to the TNF inhibitors, but instead of going after the tumor necrotizing factor, it targets Interleukins-12 and 23. These immune system cytokines also have an effect on inflammation. Stelara is the brand name for ustekinumab, which is administered in a clinic by subcutaneous injection.
Biologics are generally prescribed for those with moderate to severe PsA who have not done well with more conventional medications. Like all powerful drugs, biologics have side effects, and are not recommended for those with seriously compromised immune systems, or those with flu symptoms or infections.
Skin Treatments
The skin of those with psoriatic arthritis can generally be treated topically with the same topical agents prescribed for those with psoriasis who don't have the arthritis component. Calcipotriene, also known as calcipotriol is a form of activated vitamin D that has proved helpful in slowing the growth of psoriatic skin cells. This prescription medication is not the same as the vitamin D produced by the sun or taken orally as a supplement, which can be harmful if taken in high dosages. Because it is a topical agent, it doesn't have those same side effects. Calcipotriene is marketed under the brand name Dovonex in the United States.
