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Let’s back up: Psoriasis is a skin disease that causes inflammation in the body that sometimes shows up as red patches with silvery scales on top. The patches are commonly found on the elbows, knees, and scalp but can show up anywhere on the body (Kardashian’s psoriasis tends to flare up on her lower right leg). Arthritis is painful inflammation and stiffness in the joints.
Psoriatic arthritis is a combination of both conditions, a form of arthritis that typically affects people with psoriasis. In fact, about a third of people with psoriasis develop psoriatic arthritis, which occurs when the immune system attacks the joints.
Though there’s no cure, there are a variety of effective treatments that can help control inflammation and prevent joint damage. Here are five your dermatologist—or rheumatologist, or even your primary care physician—may prescribe as either standalone medications or in combinations of two or three.
You likely have at least one OTC version of nonsteroidal anti-inflammatory drugs, like aspirin or ibuprofen, in your medicine cabinet right now. But there are also prescription-only NSAIDs. NSAIDs are often used to reduce swelling and pain in people with mild cases of psoriatic arthritis, or until DMARDs (more on those in a sec, promise) can take effect. Depending on the NSAID she prescribes, your doctor may recommend taking it after a meal to keep your stomach from getting upset.
If you require stronger medicine to treat your psoriatic arthritis, your doc may prescribe a DMARD, or disease-modifying antirheumatic drug. These medications are often referred to as immunosuppressants because they can suppress an overactive immune system in order to reduce inflammation, which may raise your risk of infection. DMARDs not only help control swelling and pain, they can also prevent psoriatic arthritis from getting worse, and they may even put it into remission. Of the three types of DMARDs, traditional ones have been in use for the longest time (and can take kind of a long time—up to three months—to kick in). The most commonly prescribed traditional DMARD is a tablet called methotrexate.
Also known as biologic response modifiers, these DMARDs are either self-injected or delivered via infusion in a doctor’s office, and they typically work in a matter of weeks versus months. Instead of suppressing your entire immune system, they work on specific proteins, cells, and pathways, preventing arthritis from destroying your joints. While a biologic can be combined with a traditional DMARD and multiple traditional DMARDs can be combined with each other, multiple biologics are not recommended. There’s also a type of medication called biosimilars. A biosimilar is a biologic that’s similar to an already FDA-licensed biologic but with minor differences in inactive components.
Like biologics, these also block parts of the inflammatory process, but they’re (a) synthetic and (b) taken orally. The newest class of DMARDs, targeted DMARDs block the production of enzymes that play a role in initiating an inflammatory process. They can be taken instead of methotrexate, with methotrexate, or instead of—but not in combination with—a biologic.
These are what most of us refer to as plain old steroids, and they can be taken orally or injected directly into swollen joints at a doctor’s office. Doctors usually try to use the lowest dose of oral corticosteroids for the shortest time possible, as the side effects include swelling, bruising, and weight gain. Injections can lower inflammation and pain for several months, but they can also increase the loss of cartilage over time, so they shouldn’t be used long-term.
Originally Appeared on Glamour