Adjusting psoriatic arthritis medications: Advice from a Mayo Clinic expert

Finding the right medications for your psoriatic arthritis symptoms may take time and patience, but you can find relief by working closely with your rheumatologist.

The most important part of finding effective treatment for psoriatic arthritis is you — your treatment goals, your symptoms and your quality of life. Get expert input on the best approach.

Finding the right medications for your psoriatic arthritis symptoms can be frustrating at times, but hang in there. You may need to try multiple types and combinations of treatments, but you can find relief.

In this interview, April Chang-Miller, M.D., a rheumatologist at Mayo Clinic's campus in Arizona with a special interest in psoriatic arthritis, discusses what to expect from the process of finding your best treatment plan, and how to get the best results.

What can I expect while trying to find the right psoriatic arthritis medications?

Know that it often takes time to find both the right psoriatic arthritis medications and the right dosages. Your rheumatologist will expect this, and will work closely with you to find your optimal treatment plan.

You will play the most important role in this process! The information you share with your doctor about how you're responding to — and feeling on — each medication will play a critical role in determining whether you need any medication adjustments.

Don't give up if you're not feeling better right away. It may take some time, but the majority of people with psoriatic arthritis experience significant symptom relief within one year of treatment.

How will the process of finding the right medication unfold?

Your doctor will recommend an initial treatment plan based on a number of factors unique to you, including the severity of your symptoms, any other health conditions you may have and any additional medications you may be taking.

When you begin a new psoriatic arthritis medication, you're likely to have scheduled checkups. These appointments will often include lab tests, along with detailed conversations about any changes in your symptoms since you started the medication.

As you learn more about how the drug is affecting you, your doctor may adjust your dosage. Psoriatic arthritis medications often are prescribed to be increased gradually, to minimize side effects as you find your maximum dosage.

If the medication isn't producing expected results, or if your side effects are noticeable, your doctor may recommend trying a different drug.

The goal, ultimately, is to find a medication plan that provides dramatic relief from your symptoms. Your doctor may refer to this as "minimal disease activity," or MDA.

How likely is it that psoriatic arthritis medications will significantly improve my symptoms?

With regular and careful follow-up care from your rheumatologist, noticeable symptom relief is a realistic goal.

A 2014 study published in The Lancet looked at results when psoriatic arthritis symptoms were treated early and adjusted often. The most effective approach, which researchers referred to as tight control, included:

  • Setting specific treatment goals with each study participant based on results that he or she would find satisfying
  • Checking with participants monthly to evaluate how well treatments were working, based on symptoms and lab results
  • Adjusting medications at each monthly appointment if symptoms weren't improving as expected

The majority of study participants who received this approach experienced measurable relief within one year of starting psoriatic arthritis medications.

If my symptoms improve or disappear, can I stop taking medications?

Your rheumatologist will probably recommend against this, and for good reason. Psoriatic arthritis symptoms often recur after stopping drug treatment.

That doesn't mean you can't adjust your treatment plan once your symptoms improve. You may eventually be able to decrease your dosage or the total number of medications. Your doctor can help you make adjustments to your medication plan once your symptoms are under control. And if your symptoms recur, you'll be able to make new adjustments to get back to significant relief.

What else can I do to help my treatment plan be effective?

Follow all aspects of your treatment plan — which is likely to include more than just medications. For example, your doctor may send you to a physical or occupational therapist who can teach you exercises to help keep your joints flexible. The therapist may also suggest new ways to do daily tasks without putting extra stress on your joints, such as using assistive devices, and may recommend self-care to ease symptoms, such as heat and cold therapies and pacing yourself to avoid stressing your joints.

By collaborating closely with your rheumatologist, and giving the process time, you have a very good chance of finding a treatment plan that works for you long term.

Jan. 06, 2017 See more In-depth