Most effective medical treatment for psoriatic arthritis

What is Psoriatic Arthritis:

Psoriatic arthritis is a chronic, disabling disease. There are several therapies for psoriatic arthritis borrowed from rheumatoid arthritis and spondyloarthritis. DMARDs provided a little effect and there is no evidence that any of these drugs prevented disease progression. Although anti-TNF agents have shown efficacy on symptoms and radiographic progression, these new agents are expensive and not available to all patients.

Psoriasis causes scaly, red and white skin rashes. The body’s immune system is out of control and attacks the skin. Some people with psoriasis also develop arthritis with stiff, swollen joints. 

Psoriatic arthritis may affect one or many different joints. The fingers, as well as toes, may swell and look like sausages, called dactylitis. Fingernails and toenails may become pitted.

Other signs and symptoms of psoriatic arthritis include: 

• Spine inflammation called spondylitis. 
• Stiffness in back or neck and trouble bending over. 
• Tender spots or Enthesitis where ligaments and tendons go into bones. 
• Anemia, which can cause fatigue.

Diagnosis of Psoriatic Arthritis:

Diagnosing psoriatic arthritis starts with a physical exam to look for swollen or painful joints, and nail and skin changes. X-rays or scans like ultrasound, MRI or CT can show joint damage. With the help of blood tests, some other diseases could rule out and a skin biopsy helps to identify psoriasis. 

Treatments depend on your level of pain, swelling or stiffness. Mild arthritis flares may be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil or Motrin) or naproxen sodium (Aleve). 

Corticosteroids could be helpful in order to ease pain and swelling in an affected joint.
If NSAIDs are not able to ease arthritis symptoms, your healthcare provider may prescribe disease-modifying antirheumatic drugs (DMARDs), such as sulfasalazine (Azulfidine), methotrexate (Rheumatrex, Trexall, Otrexup, Rasuvo), cyclosporine (Neoral, Sandimmune) or leflunomide (Arava).

Plaquenil may be used but may cause a skin flare. People who carrying,  severe arthritis may try azathioprine (Imuran). 

Other psoriatic arthritis treatments include biologics, typically starting with TNF inhibitors, such as adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade). Some other biologics can be used for psoriatic arthritis such as secukinumab (Cosentyx) and ixekizumab (Taltz), or others classes as ustekinumab (Stelara) and abatacept (Orencia). There are a few newer oral medicines named tofacitinib (Xeljanz) that also are useful and effective.

Apremilast- (Most Recommended Medications for Psoriatic Arthritis): Apremilast 30 mg is the most commonly prescribed and most recommended medication, which acts as a selective inhibitor of the enzyme phosphodiesterase 4.
It inhibits the spontaneous production of TNF-alpha from human rheumatoid synovial cells. 

Otezla 30 mg (Apremilast Tablets) medication for the treatment of certain types of psoriasis and psoriatic arthritis. It may also be useful for other immune system-related inflammatory diseases.