Corticosteroid medications, or steroids, are not widely used in psoriatic arthritis, though they can offer pain relief. Steroids are available by prescription only and are either taken orally or injected directly into joints by a doctor. Steroids work by decreasing inflammation, thereby alleviating pain and improving range of motion.
Many physicians agree that the potential side effects of taking systemic steroids are too high, and as a result they only prescribe steroids for psoriatic arthritis patients in very rare cases. Steroids are not a good choice for psoriatic arthritis for a variety of reasons: For one thing, we don't know that they modify the disease in terms of slowing progression; in addition, steroids can cause skin psoriasis to flare, and they can actually cause a bad type called pustular psoriasis. We really try to avoid using steroids." Pustular psoriasis can occur after using systemic steroids even if the patient has never had that type of psoriasis before, and many doctors believe this can occur even after a single dose of a systemic steroid.
If steroids are going to be used at all, it has to be under the strict guidance of a physician. It can't be someone who has their cousin's prednisone at home and just takes some.
On the other hand, patients with psoriatic arthritis may require occasional steroid injections into an inflamed joint; this type of steroid use has generally not been associated with psoriasis flares and it can restore range of motion and reduce pain. Joint injections, when the joint is very hot or angry, can be very beneficial.
What About Surgery?
Surgery to repair or replace a damaged joint is one option psoriatic arthritis sufferers and their doctors sometimes have to consider when joints are badly damaged. But for most people with psoriatic arthritis, surgery isn't routinely recommended. Bergman says he reserves surgery only for those cases when it's absolutely necessary. As a rule, I don't like to send people to surgery until I think I have their disease under control, because I'd like to have as much done first before surgery. But because this disease is one that damages important joints, there are times when people will need joint replacement therapy.
Biologic medications for psoriatic arthritis work very well and should help many people avoid surgery. People with long-standing psoriatic arthritis can sometimes get very bad osteoarthritis, and that may lead to joint replacement therapy. People who are older may get osteoarthritis anyway and may need joint replacement, but I would say the vast majority of patients with psoriatic arthritis don't end up needing joint replacement surgery because of the psoriatic arthritis.
Many physicians agree that the potential side effects of taking systemic steroids are too high, and as a result they only prescribe steroids for psoriatic arthritis patients in very rare cases. Steroids are not a good choice for psoriatic arthritis for a variety of reasons: For one thing, we don't know that they modify the disease in terms of slowing progression; in addition, steroids can cause skin psoriasis to flare, and they can actually cause a bad type called pustular psoriasis. We really try to avoid using steroids." Pustular psoriasis can occur after using systemic steroids even if the patient has never had that type of psoriasis before, and many doctors believe this can occur even after a single dose of a systemic steroid.
If steroids are going to be used at all, it has to be under the strict guidance of a physician. It can't be someone who has their cousin's prednisone at home and just takes some.
On the other hand, patients with psoriatic arthritis may require occasional steroid injections into an inflamed joint; this type of steroid use has generally not been associated with psoriasis flares and it can restore range of motion and reduce pain. Joint injections, when the joint is very hot or angry, can be very beneficial.
What About Surgery?
Surgery to repair or replace a damaged joint is one option psoriatic arthritis sufferers and their doctors sometimes have to consider when joints are badly damaged. But for most people with psoriatic arthritis, surgery isn't routinely recommended. Bergman says he reserves surgery only for those cases when it's absolutely necessary. As a rule, I don't like to send people to surgery until I think I have their disease under control, because I'd like to have as much done first before surgery. But because this disease is one that damages important joints, there are times when people will need joint replacement therapy.
Biologic medications for psoriatic arthritis work very well and should help many people avoid surgery. People with long-standing psoriatic arthritis can sometimes get very bad osteoarthritis, and that may lead to joint replacement therapy. People who are older may get osteoarthritis anyway and may need joint replacement, but I would say the vast majority of patients with psoriatic arthritis don't end up needing joint replacement surgery because of the psoriatic arthritis.
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