Showing up prepared for your doctor’s visit is one of the best ways to find the treatment that’s right for you. These questions can help you learn more about your test results and treatment options.

Psoriatic arthritis (PsA) is a chronic inflammatory form of arthritis that develops in the major joints of some people with psoriasis. PsA requires a different treatment approach than psoriasis alone.

PsA can be classified from mild to severe. Mild PsA affects four or fewer joints. Severe PsA affects five or more joints and is also known as polyarticular psoriatic arthritis.

If you have severe PsA, you need to see a rheumatologist, a doctor who specializes in rheumatic diseases. The following are some questions to ask your doctor during your next visit.

To be diagnosed with PsA, you’ll need to have a series of tests done.

Screening tests

Doctors use certain questionnaires as screening tools for PsA. Your answers can help your doctor decide if you need further testing to check for PsA.

Examples of these questionnaires include the:

Questions you may be asked include “Have you ever had a swollen joint (or joints)?”

The PEST and PASE are intended to screen for PsA in people with psoriasis, while the ToPAS can also be used for people without psoriasis.

Your doctor may also examine your skin and nails. Most people with PsA have nail changes, such as pitting, and the skin lesions typical of psoriasis.

Lab tests

Lab tests that show a high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level might indicate PsA.

ESR and CRP are acute-phase reactants. This means your ESR and blood level of CRP are high when anything, such as PsA, causes inflammation in your body.

However, only around half of people with PsA have elevated ESR and CRP levels. More research is needed to better understand the role of these markers as a diagnostic tool.

Imaging tests

Doctors usually perform imaging tests to verify a PsA diagnosis. These tests can also help them rule out similar health conditions, such as rheumatoid arthritis.

Common imaging tests for PsA include X-rays, ultrasounds, and MRIs.

If you have PsA, you’re likely to also have progressive joint damage and disability. You may not be able to prevent joint damage completely. However, your doctor can recommend techniques and medications that can help.

For example, your doctor may suggest exercises. Exercise can help ease your symptoms and remove stress from your joints. It can also help you maintain a moderate weight. Ask your doctor what types of exercise are best for you.

The earlier you start treatment for PsA, the better.

A 2024 study found that starting treatment within 1 year of the onset of symptoms helped to slow disease progression.

A 2022 study concluded that starting treatment more than 6 months after symptom onset led to joint erosion and worse physical function over time.

Conditionally introduced in 2018, the “target-to-treat” approach has now gained widespread recommendation. This involves creating a specific goal and an objective way to measure progress. The treatment plan is changed until the goal is achieved.

Doctors are also starting to take a more patient-centered approach to treating PsA. This means they’re more likely to consider factors such as how the condition is affecting your daily life.

Talking openly about your symptoms and how they affect your ability to function or enjoy activities can help your doctor develop a treatment plan that’s right for you.

The medications you take will likely depend on the severity of your PsA.

Biologics

The most recent treatment guidelines for PsATrusted Source recommend a type of biologic drug known as a tumor necrosis factor (TNF) inhibitor as the first-line therapy for people with active PsA.

This is a change from previous guidelines in which methotrexate was the recommended first-line therapy, followed by TNF inhibitors.

Biologic drugs that target the TNF involved in psoriasis can also help you manage symptoms of PsA:

  • adalimumab (Humira)
  • certolizumab pegol (Cimzia)
  • etanercept (Enbrel)
  • golimumab (Simponi)
  • infliximab (Remicade)

Ustekinumab (Stelara) is another biologic that can be used to help treat psoriasis or PsA. However, it isn’t a TNF inhibitor.

Disease-modifying anti-rheumatic drugs (DMARDs)

DMARDs are used to treat moderate to severe PsA.

If your TNF inhibitor isn’t effective, your healthcare professional may prescribe a different class of biologic instead. A DMARD may be added to your treatment regimen to boost the efficacy of the new biologic.

The DMARDs used in the treatment of PsA are:

  • apremilast (Otezla)
  • cyclosporine A, which is used for skin-related symptoms
  • leflunomide (Arava)
  • methotrexate (Rasuvo, Otrexup)
  • sulfasalazine (Azulfidine)

The Food and Drug Administration (FDA) has approved the use of Otezla for people with PsA. However, other medications are used off-label to treat the condition.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are used for treating mild PsA. NSAIDs are available both as over-the-counter (OTC) drugs and as prescription drugs.

Examples of OTC NSAIDs include:

  • aspirin
  • ibuprofen (Advil, Motrin)
  • naproxen (Aleve, Naprosyn)

An example of a prescription NSAID is celecoxib (Celebrex), which is considered an off-label treatment for PsA.

Glucocorticoids (corticosteroids)

Glucocorticoids, which are also known as corticosteroids, can be taken orally or injected directly into the affected joints.

Oral forms aren’t recommended for PsA. This is because they can cause the skin disease to flare up.

They also increase the risk of a person developing a severe form of PsA called erythrodermic or pustular psoriasis. This condition causes raised bumps on the skin that are filled with pus (psoriatic pustules). It can be life threatening.

Injections can be helpful when a flare-up causes pain in one or two of your joints. When injected into a joint, these medications work well to quickly relieve inflammation and swelling. However, repeated injections can cause joint damage and other complications, so they should be given sparingly.

All steroids can cause significant side effects, such as:

  • bone loss
  • mood changes
  • high blood pressure
  • weight gain

You and your doctor can work together to create a plan to manage your PsA effectively. Here are some steps you can take to make the most of your visit:

  • Jot down a list of all of your symptoms and bring it with you.
  • Keep a running list of your questions before you get there.
  • If your doctor suggests a medication, ask how well it usually works to treat PsA.
  • Ask your doctor about any side effects a medication may cause.
  • Share any concerns with your doctor.