Psoriatic Arthritis Drug Treatment

Psoriatic Arthritis Drug Treatment

Psoriatic Arthritis Treatment

Psoriatic arthritis drug treatment is common, the conventional treatment of the arthritis symptoms of psoriatic arthritis is most always based on pharmaceutical drugs. The treatment initially involves a combination of anti-inflammatory medications (NSAIDs) and exercise.

If progressive inflammation and joint destruction occurs despite NSAIDs treatment, more potent medications such as methotrexate, corticosteroids, and antimalarial medications (such as hydroxychloroquine, or Plaquenil) are used. Let’s look a little bit deeper into the different drugs used in cases of psoriatic arthritis

Systemic Treatments

Oral medications are usually reserved for those who have severe forms of psoriasis (more than 20 percent of the body covered). Powerful drugs are prescribed for those who complain to their doctor about a significantly reduced quality of life, for example when serious psoriasis of the palms or soles of the feet prevents a person from living a normal life.

They are also given to those with psoriatic arthritis, and these make up about 10 to 15 percent of patients who have been diagnosed as having psoriasis. These are powerful synthetic agents that reduce the dramatically accelerated cellular reproduction of the skin found in psoriasis. These drugs are prescribed either as pills, or as a subcutaneous injection into the muscle, and they are commonly used in combination with either the topical therapies or UV treatment, especially when a psoriasis patient does not respond to a single type of treatment.

The most common forms of systemic treatments for psoriasis are methotrexate, cyclosporine and retinoids. While these drugs can provide considerable benefits in clearing chronic psoriasis, this action comes at a huge cost of producing both acute as well as chronic side effects. I have had many psoriasis patients over the years see me who wanted to come off these medications due to the side effects. The side effects occurred either shortly after starting therapy (acute side effects) or appeared only after prolonged usage (chronic side effects).

Some patients believe that if they stay on a drug for several years and then developed side effects, that these are not linked to the drug, but are in fact “another disease” that needs treating with yet another drug. And so the pharmaceutical merry-go-round continues. When you take any of these powerful drugs, you need regular check-ups with your doctor, including blood tests, blood pressure, etc.


Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications that are helpful in reducing joint inflammation, pain, and stiffness. Examples of NSAIDs include aspirin, indomethacin (Indocin), and diclofenac (Voltaren). The problem with drugs are the inherent side-effects, and the most frequent side effects include stomach upset and ulceration, but these drugs can also cause more serious side effects such as gastrointestinal bleeding and even stroke.

Disease Modifying Medications

Patients who experience progressive joint destruction in spite of NSAIDs are deemed to be by their rheumatologist or specialist to be candidates for more aggressive disease-modifying medications. Disease-modifying medications are regarded by your doctor as being important to prevent progressive joint destruction and deformity.

Chemotherapy agents. Methotrexate is the drug of choice with pain in auto-immune arthritis. I see patients with auto-immune joint problems who have conditions such as lupus, scleroderma, rheumaoid arthritis, psoriatic arthritis and ankylosing spondylitis take methotrexate and steroidal drugs and may “top-up” these drugs with pain relief such as diclofenac or paracetamol/codeine tablets. These medications include methotrexate, are used orally or can be given by injection on a weekly basis for psoriatic arthritis. Methotrexate is a very strong drug and causes many undesirable effects when given long-term, and to be better informed you can read a lot more on the side-effects of methotrexate on this good webpage. Methotrexate can cause bone-marrow suppression as well as liver damage with long-term use, and regular monitoring of full blood testing, including liver function should be performed 3 or 6 monthly during therapy with methotrexate. Antimalarial medication such as hydroxychloroquine (Plaquenil) is also used for persistent psoriatic arthritis. The known side effects include injury to the retina of the eye, and regular 3 or 6 monthly ophthalmologist examinations are suggested while using Plaquenil. Read more on the web page called the side effects for plaquenil. There are natural options for psoriatic arthritis which are effective and 100% side-effect free. Injectable gold (Solganal) and oral gold have potential side effects including bone-marrow suppression which can lead to anemia and low white blood counts and cause adverse kidney effects, including the loss of protein or blood in the urine. Gold injections have of late become obsolete since methotrexate has become more popular. Sulfasalazine is an oral sulfa-related medicine that has also been helpful in some patients with persistent psoriatic arthritis. Traditionally, Azulfidine has been an important agent in the treatment of ulcerative and Crohn’s colitis. It should be taken with food, as it too can cause gastrointestinal upset. TNF-blockers. Medications that block the chemical known as tumor necrosis factor (TNF) are another treatment option for severe cases. The TNF-blockers etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira) can be very effective for severe psoriatic arthritis and they can significantly improve or eradicate both the psoriasis and the arthritis as well as stop progressive joint damage. Corticosteroids are potent anti-inflammatory agents. Corticosteroids can be given by mouth (such as prednisone) or injected (cortisone) directly into the joints to reduce inflammation. They can have side effects, especially with long-term use. These include thinning of the skin, easy bruising, infections, diabetes, osteoporosis and, rarely, bone death (necrosis) of the hips and knees.

Skin and Joint Symptoms Linked

While the relationship between the skin disease and joint disease is not clear, many clinical cases have revealed that there is an improvement of the arthritis simultaneously with clearing of the psoriasis. Patients with psoriasis can benefit by direct sunlight exposure, ultraviolet psoriasis treatment and ocean water.

Exercise May Help

Exercise can be done at home (a good occupational therapist or physiotherapist can help significantly here) and is customised according to suit each patient. Warm-up stretching, or other techniques, like a hot shower or heat packs (wheat bags are good) are helpful to relax muscles prior to exercise. Ice application after the routine can help minimise post-exercise soreness and inflammation. In general, exercises for arthritis are performed for the purpose of strengthening and maintaining or improving joint range of motion. They should be done on a regular basis for best results and you may also want to consider Tai chi or yoga.

Surgery For Psoriatic Arthritic Is A Last Option

Patients who have severe destruction of the joints may benefit from orthopedic surgical repair. Total hip joint replacement and total knee joint replacement surgery are now commonplace in many hospitals throughout countries such as the USA, England, Australia and NZ.

Can Pharmaceutical Drugs Be Causing My Psoriasis?

Can Pharmaceutical Drugs Be Causing My Psoriasis?

Can pharmaceutical drugs be causing my psoriasis? This is something many psoriasis patients may be thinking. The tragedy I have found is that a patient can sometimes experience many of the typical signs and symptoms of psoriasis, like itchy, dry, or cracked skin. There may even be patches of plaque forming that look just like psoriasis. This “mystery illness” may even lead the patient down the road of taking an over the counter drug; they may visit a doctor or chemist and buy a cream, ointment or a tablet on the advice of the pharmacist in the belief that they have developed a new illness, one that affects their skin and looks and behaves a lot like psoriasis.

Article of interest: What causes psoriasis?

What this patient may be unaware of is that he or she may well have in fact a drug-induced (iatrogenic) case of psoriasis. Yes, it actually happens, you can develop psoriasis from taking a pharmaceutical drug.

In some situations it can be tricky for psoriasis patients to take pharmaceutical drugs for other unrelated conditions, such as high blood pressure. It is most unfortunate that some people who actually have pre existing psoriasis may face a Catch-22 situation, when a drug they take for another condition may cause their red, scaly or itchy rashes to get far worse, or may even bring on a case of psoriasis for the very first time.

Certain drugs, particularly those for bipolar disorder, high blood pressure, and hepatitis, can provoke psoriasis for reasons doctors don’t yet “fully understand”, according to a leading medical website I just viewed. Well it’s pretty obvious to me what is occurring, the drug is causing a degree of liver and/or kidney toxicity, something Dr. John Pagano (Healing Psoriasis) discovered many years ago. Whenever a patient cleans up his or her diet and lifestyle, and undertakes a good detoxification program, their psoriasis almost disappears.

What doctors believe is that certain medications trigger or worsen psoriasis outbreaks in those who are genetically predisposed.

Here is a quote from The Journal of Clinical and Aesthetic Dermatology :

“Psoriasis is a commonly encountered dermatosis with a variety of internal and external paradoxical factors contributing to the clinical course of the disease. There are several drugs described in the literature that have been associated with the initiation, exacerbation, and aggravation of psoriasis. Understanding the pathophysiology can provide clues to treatment and management of drug-induced and drug-aggravated psoriasis, which may be indistinguishable from idiopathicpsoriasis. The clinical manifestations of drug-associated psoriasis can range from plaque-type psoriasis to severe erythroderma, thus warranting astute and sustained clinical observation”.

Psoriasis Patients May Take Other Drugs

Do you have psoriasis and another medical condition as well? Analysis of individuals with chronic psoriasis has revealed some interesting statistics2. Over one quarter of those with psoriasis have been diagnosed with high blood pressure (28.2%), diabetes (10.5%) and high cholesterol levels (12.5%). Bearing this in mind, many patients with psoriasis can be on multi-drug regimens; therefore a careful analysis of the various medications that can interact with each other as well as exacerbate psoriasis is very prudent.

Pharmaceutical drugs have several different ways in which they can affect a person’s susceptibility of developing psoriasis, including:

Stimulate the development of psoriasis in susceptible or in non-susceptible individuals.Exacerbate pre-existing psoriatic skin lesions.Induce lesions or lesions different to those experienced by psoriasis patients.Developing drug-resistant psoriatic lesions.

Sometimes a psoriasis patient may develop nail or scalp psoriasis after commencing a drug, or other psoriatic symptoms she may not have previously experienced. The drugs that appear to have the strongest casual relationship with psoriasis are the following:

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as aspirin, paracetamol, ibuprofen, etc.Beta-blockers (blood-pressure)Lithium (bipolar depression)Tetracyclines (antibiotics)Hydroxychloroquine (synthetic antimalarial drugs)

The Drugs Most Commonly Linked In Causing Psoriasis

NSAIDs. (Non-Steroidal Anti-Inflammatory Drugs) such as aspirin, paracetamol, ibuprofen, etc. I have seen many patients over the years that have come into my clinic complaining of psoriasis, who have previously not had psoriasis – until they started taking a NSAID drug regularly. Maybe this is you? Can you relate to having psoriasis since taking a common drug like Tylenol or Advil? Stop this drug and look for an alternative.Beta-Blockers. These are drugs commonly prescribed for high blood pressure and have been extensively studied, and have been found to exacerbate psoriasis patients in a quarter to a third of patients who take them. If you are unsure if your anti-hypertensive drugs are Beta-blockers, go to Google and do an online search. Psoriatic lesions or eruptions will appear in those susceptible from 1 to 18 months after the initiation of Beta blocker therapy, and they have even been implicated in those who have never had psoriasis before. Many different kinds of skin rashes have been implicated with this class of drug, so check it out carefully. Beta-blocker provoked psoriasis improves upon discontinuation of medication, but usually does not completely resolve.Lithium. Lithium is a drug used to control psychiatric illnesses like bipolar, also commonly termed manic depression. Lithium can provoke or aggravate psoriasis in almost half of psoriasis that take it. An interesting study conducted in 2003 revealed that when patients were given omega-3 at the same time, this reaction was diminished.Antibiotics. Drugs such as tetracycline, minocycline and amoxicillinand various other antibiotic drugs are known to cause skin reactions, ranging from mild to most severe, even anaphylactic skin reactions.Some antibiotics are known to cause photosensitization, which may result in predisposed patients with psoriasis to experience exacerbation through the “Koebner phenomenon” secondary to sun exposure. In one study, investigators reported that 4 percent of patients experienced exacerbation of psoriasis as a consequence of antibiotic use. It has also been suggested that tetracyclines should be avoided in patients with clinical evidence of psoriasis, as well as in healthy individuals with a genetic predisposition forpsoriasis.Anti Malarial Drugs. These drugs are used not only to treat malaria, but are also commonly prescribed in auto-immune conditions such as psoriasis, lupus and rheumatoid arthritis. Many have been known to cause acute flare-ups in those with psoriasis in as little as a few weeks after commencement of the drug.

Good advice is to use as little of the medicine as you can get away with preferably, or ask your doctor if you can try an alternative drug. There is little point remaining on any drug that cases strong or uncomfortable side effects. Be sure to consult with your doctor or specialist before you reduce or consider discontinuation of any drug, it is the right and responsible thing to do.


Immune Boosting Psoriasis Foods

Consider Eating Immune Boosting Psoriasis Foods

Immune boosting psoriasis foods are an important consideration for those who are interested in tackling the inflammation commonly encountered with psoriasis. If you have read The Psoriasis Diet book (one of the 11 books that form The Psoriasis Program), you will have read of the importance of following a low-allergy diet for several weeks. This is stage-2 of the three-stage diet approach I recommend for psoriasis patients. Because your immune system is very much involved in psoriasis, you will want to remove any possible foods from your diet that may be challenging your immune system. These foods could well be responsible for triggering some of your flare-ups. You’ve probably worked out by now that your diet plays a leading role in improving or worsening your psoriasis, and that your immune system plays a fundamental role in keeping inflammation under control. Doesn’t it make sense to reduce or avoid foods that inappropriately aggravate or stimulate immunity, and include those foods that allow your immune system to respond appropriately? Of course it does. Psoriasis after all is regarded as an autoimmune disease, and it therefore makes perfectly good sense to follow an autoimmune kind of diet.

Throw Out Junk Foods And Eat Immune Boosting Foods

One of the best ways to boost immunity is to first throw out ALL those junk foods, packaged foods and convenience foods from your diet. I’ve spoken at length about this in The Psoriasis Diet book, so you may want to revisit that book. There is little point in improving your diet and selecting the best immune boosting foods if you continue to consume those foods and drinks that contain many chemicals, toxins, preservatives, sugars, etc.

Immune-Boosting Fruits & Vegetables To Consume With Psoriasis

Immune-Boosting Food – Green Leafy Vegetables

Eat your vegetables, how many times have you heard your parents tell you this when you were growing up? People with psoriasis in particular benefit a great deal from eating green leafy vegetables for various reasons. You probably know that vegetables contain plenty of important vitamins and minerals that will keep you healthy, but did you know that there are special immune-boosting compounds that only recently are being discovered by modern science?

An interesting study1 was conducted in 2011 at Cambridge University in England, which has discovered a connection between green leafy vegetables and a powerful body-wide immune enhancing response. Researchers at the Barbraham Institute discovered that when mice were fed a diet entirely lacking in green leafy vegetable matter, that they had a remarkable decline in their immune activity within only two to three weeks. The test mice had an almost amazing 80 percent reduction in intra-epithelial lymphocytes (IELs), one of the major immune cells found in most all mammals, including mice and humans.

It was discovered that a powerful relationship exists between IEL cells and specific chemical compounds found in green cruciferous vegetables such as kale, broccoli and cabbage. Chemicals in these particular types of leafy green vegetables trigger a powerful immune boosting activity in cell surface proteins (AhR proteins) found on the surface of white blood cells, otherwise known as lymphocytes. IEL cells are known to destroy infectious and foreign material to protect the organism.

These immune cell surface proteins in themselves help the body by making our DNA less vulnerable to attack by our immune system which may have gone on the attack of foreign particles in our blood, such as dead cells, parasites, viruses, pollens and more.

Although researchers are still saying its early days yet with this kind of research, they are claiming that green leafy vegetables in particular hold the key to boosting a person’s immune system on various levels, besides providing our bodies with an abundance of vital nutrients including vitamins and minerals.

Immune Boosting Food – Yogurt

When it comes to improving your immune system, you just can’t beat a good quality, naturally made yogurt when it comes to psoriasis. Be sure to read all about the benefits of yogurt in The Psoriasis Diet. Yogurt (without artificial sugars, fruits, etc.) contains plenty of live and beneficial bacteria called probiotics. These friendly bugs are healthy bacteria that keep the intestinal tract and digestive system free of disease-causing germs, but they also calm the immune system and help the body reduce inflammation.

An Austrian study found that taking 7 ounces of yogurt a day (about 1 Cup, around 200 to 250 gr.) was as effective as taking several probiotic capsules daily. An interesting study conducted in Sweden that lasted 80 days, revealed that 180 employees of a factory who drank a daily yogurt drink (Lactobacillus reuteri) had almost one third (33%) fewer sick days than those who did not (who took a placebo).

I’ve always recommended my psoriasis patients take a small bowl of yogurt every day for this reason; it is most beneficial for the digestive tract because it encourages the proliferation of beneficial bacteria and discourages the bad. And we should all know that good health starts in the gut, and if you want to reduce your psoriasis flare-ups, you will want to regularly consume yogurt.You may like to read the page regarding the top ten skin tips for psoriasis.

Some people will tell you to “avoid all dairy products, including yogurt” – ignore them. If you do happen to react to yogurt, try a different brand or a top-quality made product from a reputable health food store. Start with a small amount if you have little experience in cultured foods because the bacteria in your gut may find the influx of these beneficial bacteria a bit overwhelming at first, making you think you are “reacting” to the food.

Turmeric And Ginger For Psoriasis

Turmeric And Ginger For Psoriasis

Why Turmeric And Ginger Are Good To Use With Psoriasis

Should you use turmeric and ginger for psoriasis? You may well be familiar with turmeric, the yellow spice commonly found in curry, or ginger, another spicy herb used in cooking and baking. I’ve been recommending the powdered root of both turmeric and ginger for psoriasis for many years.

These spices can come either as powdered or in their fresh form, and definitely make sense if you have psoriasis, because of their anti-inflammatory and antioxidant properties

I’ve read many studies and articles on turmeric especially, as well as having spoken to many psoriasis and psoriatic arthritis patients over the years who have told me that they have received benefit from especially from using turmeric in their diet. Should you give it a go? What have you got to lose by trying; these powdered spices are cheap, especially when purchased in bulk at your local Indian or Asian store.

One thing I must tell you, you will need to be patient when using the spices turmeric and ginger in your diet, because results just don’t happen overnight. Expect to use turmeric for at least 4 to 6 months on a daily basis before you really notice a difference. But in saying that, I’ve seen some patients get great results within a month of usage.


Cucurmin is the active ingredient found in turmeric root, and many studies have revealed that it is safe to take even in high dosages for prolonged periods of time. In some Asian countries, turmeric is used to treat all kinds of chronic conditions affecting the immune system, like skin cancers, scleroderma, various tumors affecting the skin, breast, colon and even the pancreas, but it is also used to treat psoriasis in India with good effect.

Cucurmin fights inflammation, protecting the cells of the body from oxidative stress caused by free radicals, and inflammation, mainly due to the inhibition of nuclear factor KB. Cucurmin is also remarkable not only in that is strongly reduces inflammation, but it has also been found to be proangiogenic, meaning it promotes the development and growth of new blood vessels. These actions mainly occur due to the fact that turmeric can be used for prolonged periods of time in high dosages without causing toxicity or side effects.

The National Institute of Health in Washington DC conducted studies into psoriasis and turmeric and found that Cucurmin could be successfully used in the treatment of healing psoriasis skin lesions and reducing any inflammation. A study found that cucurmin-rich gel was applied to psoriatic lesions, more plaque reduction was noticeable, and in some cases an 8-week treatment resolved some cases entirely. Even the National Psoriasis Foundation has stated that turmeric can help to minimize any skin-flare ups due to psoriasis.

A good tip I recently discovered is that for cucurmin to work properly in the body in needs to be taking in a little oil or fat because cucurmin is a fat-soluble phytonutrient.

How To Use Turmeric With Psoriasis

There are different ways to use turmeric, it can be taken internally as well as applied topically and my suggestions are to try both.

Use 1 teaspoon per day in your drink, smoothie or mixed in with foods or snacks. Be sure to have some oil or fat, like coconut oil for example, as this will help to liberate cucurmin in your body more readily. In a dietary supplement form. Some psoriasis patients may want to take turmeric in as a capsule or tablet form rather than as the powdered spice on a daily basis. Turmeric stains clothing and utensils readily and you will need to be aware of this! My preference is for the raw powdered spice, because it is low-cost, and if used long enough and in sufficient dosage, then the results will be forthcoming. As a paste, turmeric can be applied externally to psoriatic lesions and areas of plaque. Make up a thick paste of turmeric and pure water in a glass bowl. It the mixture is too thin, just add a little more powder, if too thick, add a little more water. Apply the paste to the affected area and leave overnight for the best results. Cover with a gauze bandage to prevent the paste moving or staining any bedding or clothing. In the morning, remove the bandage and rinse gently with warm water. Don’t give up! I’ve had patients take turmeric powder for several months until they started noticing some improvements, and significant improvements after one year to the point where they hardly noticed any more psoriatic skin flare-ups! And when a flare did occur, it was quickly brought under control with an application of turmeric paste for three days in a row.

Curcumin is the most active ingredient found in turmeric, it affects the body’s immune system in different ways and has a most powerful ability to control several molecular pathways that have been linked with psoriasis. The incredible ability of curcumin to promote various pathways like gene transcription factors, inflammatory cytokine pathways and various growth factors means that it has been studied for the many potential benefits for skin conditions like psoriasis, skin cancers, dermatitis, acne, wound healing and even keloid scars.

Curcumin Dosage

You can take turmeric in a “non-standardized” dose as it is, the straight root ground-up, or you can take it as a standardized natural medicine. The normal adult dosage is between 300 to 700 mgs of a standardized curcumin product (capsule or tablet usually) three times daily with meals. I don’t think that there is a recommended dosage for children.

No Toxicity Reported With Turmeric

It is encouraging to note that unlike pharmaceutical drugs aimed at psoriasis, high doses of curcumin extracts have not demonstrated any toxicity, apart from nausea and very mild diarrhea. I have recommended turmeric for over twenty years and never heard of any adverse effects, and regularly hear good and even excellent feedback from patients.

Some research has shown that standardized curcumin extracts (oral cucuminoid C3 complex) may be of more therapeutic benefit than using just plain turmeric powder.

Turmeric Or Ginger for Psoriatic Arthritis?

What is the best to use with psoriasis, should you use turmeric or should you use ginger? If you have psoriatic arthritis, I’d like you to try powdered ginger, take one teaspoon a day mixed into a little water. Make up a paste first, and then add a little more water and then swallow, and have before meals once per day. I’ve found ginger to be of more benefit to the joints when it comes to reducing inflammation, and have received very good feedback from a few patients with psoriatic arthritis. Why don’t you try it, you have nothing to lose!

I have discovered through trial and error that ginger works better for the inflamed joints that those with psoriatic arthritis suffer from than turmeric does. About twenty years ago I used to work in a health-food shop when a lady with psoriatic arthritis came in and asked if we stocked a product called Zinax, apparently made by a company for arthritis. It turned out that a drug company had discovered that there was a good market for an encapsulated powdered ginger root product for arthritis. That product is still sold today by the same drug company, and carries a hefty price tag when compared with the powdered ginger root you can buy in bulk from your health food store!

Using Ginger Powder With Psoriatic Arthritis

Try making a rather stiff paste that you apply to joints, wrap some cling-film plastic around the joint (no too tightly!) and then a little gauze bandage. Leave overnight, and gently wash the ginger powder away in the morning. You can get an even better effect by grating the fresh ginger root (no need to peel it) and packing this around the affected joint/s, wrap with cling film and leave overnight. Take one teaspoon of turmeric powder as instructed above each day when applying the ginger to the affected joint. Be patient! Results will come with the persistent use of ginger and turmeric.


I’ve heard many doctors tell me that patients need to be careful when taking turmeric or ginger long-term, especially if they are taking conventional medications. If in doubt, ask your naturopath or doctor who has experience in complementary (alternative) medicine. I’ve never seen any problems occur, even with patients who have been taking high blood-pressure medications, sleeping pills, antidepressants, etc.

I’m often perplexed why medical doctors worry about recommending patients to consume more natural foods, herbs and spices, believing they “interact” with the toxic drugs they themselves prescribe. Doesn’t it make more sense for a doctor to first recommend for example curcumin or ginger, rather then immediately place their patient on a drug targeting the symptoms of psoriasis? Of course it does, but their lack of training in this area can tend to make them down on things they are not up on.

The Psoriasis Program

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