Meloxicam Safety in Psoriasis Patients
Meloxicam and other NSAIDs should be avoided in patients with psoriasis, as they are known to trigger or exacerbate psoriatic disease. 1
Evidence Against NSAID Use in Psoriasis
The American Academy of Dermatology explicitly identifies NSAIDs as medications that worsen psoriasis and recommends they be avoided. 1 This is a clear contraindication based on the known mechanism of psoriasis exacerbation by this drug class.
Long-term epidemiological data supports this concern: regular NSAID users with more than 10 years of use demonstrated a hazard ratio of 2.10 (95% CI: 1.11-3.96) for developing psoriatic arthritis compared to non-users. 2 This suggests NSAIDs may not only exacerbate existing psoriasis but potentially contribute to disease progression.
Limited Role in Psoriatic Arthritis Only
NSAIDs may be used cautiously in psoriatic arthritis patients solely for symptomatic relief of musculoskeletal manifestations, but they provide no disease-modifying benefit and carry the risk of worsening skin disease. 3
The 2020 EULAR guidelines state that NSAIDs "may be used to relieve musculoskeletal signs and symptoms" in psoriatic arthritis. 3 However, this recommendation applies specifically to the arthritic component, not the skin disease. When patients have insufficient response to NSAIDs for enthesitis, dactylitis, or axial disease, guidelines recommend escalating to biologic DMARDs rather than continuing NSAID therapy. 3
Clinical Algorithm for Decision-Making
For psoriasis without arthritis: Absolutely avoid meloxicam and all NSAIDs. 1
For psoriatic arthritis with active skin disease:
- Use NSAIDs only as short-term bridging therapy while initiating DMARDs 3
- Monitor closely for psoriasis flares
- Prioritize methotrexate or biologics that treat both joint and skin manifestations 3
For psoriatic arthritis with minimal/controlled skin disease:
- NSAIDs may be used for symptomatic relief 3
- Limit duration and dose
- Maintain vigilance for new skin lesions or worsening plaques
Critical Pitfall to Avoid
The most dangerous error is prescribing NSAIDs for pain management in a patient with unrecognized or subclinical psoriasis, as this can precipitate severe flares or unmask psoriatic arthritis. 2 Any patient requiring chronic NSAID therapy should be screened for psoriatic skin lesions, nail changes, and joint symptoms before initiating treatment.