Everything You Should Know About Psoriatic Arthritis Medications
If you’ve recently been diagnosed with psoriatic arthritis, you may be feeling a mix of relief and fear. Relief because you finally have answers (and it can often take years to get a diagnosis)—and fear because taking a new drug or treatment is like entering unknown territory. But treatment can help you manage your symptoms, easing your pain or discomfort. Here’s what you need to know about your psoriatic arthritis treatment options as you and your doctor decide the right plan for you.
Making a Medication Decision
“Treatment for psoriatic arthritis is largely dependent on what features of the disease a person has and how a person has responded to previous medications,” says Navya Parsa, M.D., a board-certified rheumatologist at Columbus Arthritis Center in Ohio.
The medications most often prescribed for psoriatic arthritis include medications used for other forms of arthritis, says Jessica Nouhavandi, Pharm. D., lead pharmacist and co-founder of online pharmacy Honeybee Health. But because psoriasis usually accompanies psoriatic arthritis, your doctor will likely want to treat your skin and joint issues at the same time.
“The main goal of psoriatic arthritis treatment is to reduce the inflammation that is leading to the pain, as well as to also ease the scaly and itchy skin patches,” Nouhavandi says.
To achieve that goal, there are several different medications that can be recommended or prescribed.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
If psoriatic arthritis is mild, NSAIDs may be enough. These drugs work by preventing your body from making the chemicals that lead to inflammation. There are several over-the-counter options, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). Stronger NSAIDs, such as Celebrex and Voltaren, may also be prescribed.
With NSAIDs, nausea is a common side effect, but it can be minimized if the medication is taken with food.
More rarely, these drugs can increase the risk of serious GI events, such as bleeding and ulceration. They may also put patients at an increased risk of heart attack and stroke, may cause kidney damage, and may increase blood pressure. Therefore, NSAIDs may need to be avoided in patients who already have an increased cardiovascular or kidney disease risk.
DMARDs (Disease-Modifying Antirheumatic Drugs)
If your psoriasis is moderate to severe, or resistant to NSAIDs, nonbiologic DMARDs can be prescribed instead. These work by slowing the pain and reducing inflammation, swelling, and joint and tissue damage.
Methotrexate is commonly used as a first-line DMARD treatment for those with psoriatic arthritis. Before starting to take methotrexate, patients should undergo lab tests to confirm normal liver function, since the most serious potential side effect is liver toxicity. Caution is also necessary in people with impaired kidney function.
If you’re prescribed methotrexate, you may also need to take folic acid supplements, as methotrexate can lower folate levels. Methotrexate shouldn’t be taken during pregnancy, and people taking it should avoid alcohol, as this combination can increase the risk of liver toxicity.
Arava is another DMARD that is used in patients who have mild to moderate psoriasis and/or psoriatic arthritis. It is often chosen for patients who can’t tolerate methotrexate. Know that this medication has a liver toxicity risk, and it shouldn’t be used in pregnancy.
Another option is Otezla, which can be prescribed for patients with multiple comorbidities, since it is considered very safe. It has a rare risk of depression (about 1 in 100) that you and your doctor will have to watch for.
If psoriatic arthritis is severe, or resistant to nonbiologic DMARDs, a biologic medication may be prescribed. Often these are tumor necrosis factor (TNF) inhibitors, which work by blocking the activity of TNF, which causes inflammation in the body and ultimately leads to psoriatic arthritis.
TNF inhibitors include Cimzia, Enbrel, Humira, Remicade, and Simponi. Most of these medications are given through subcutaneous injections, though some are given through an IV. Before starting one, you’ll need to be screened for latent tuberculosis (TB), as they can put you at risk of serious infections, including full-blown TB. Serious potential side effects include demyelinating disease, hepatitis B reactivation, drug-induced lupus, heart failure, and liver toxicity.
If your condition is resistant to TNF inhibitors or there are contraindications, biologics with a different mechanism of action can be used. One class is called anti-IL17 therapy; it includes Cosentyx and Taltz, which are given by injection. These also require TB screening, since they, too, can lead to serious infections. Another common side effect is diarrhea.
Another class is called anti-IL23 inhibitors, which includes Stelara and Tremfya, as well as additional medications that have been approved for psoriasis and in clinical trials for psoriatic arthritis: Ilumya and Skyrizi.
Working with Your Doctor
It’s important to remember that most medications used to treat psoriatic arthritis are designed to suppress the immune system, says board-certified rheumatologist Frank Migliore, D.O., a rheumatologist at AHN Rheumatology in Monroeville, Pennsylvania.
“Psoriatic arthritis is caused by the immune system ‘attacking’ things it is not supposed to—the joints and skin,” he explains. “By suppressing the immune system, these medications block that ‘attack.’”
And so, it’s important that your doctor understand your medical history before selecting your treatment. This includes any other conditions you have, other medications or supplements you take, and how you’ve responded to other psoriatic arthritis medications in the past.
The severity of your condition will also play a role in your doctor choosing the right medication for you, says Migliore.
Understanding the Risks
Immunosuppressive medications may increase a patient’s risk of infections and could weaken the body’s ability to fight off infections, says Parsa.
“If you have a history of tuberculosis or viral hepatitis, be sure to tell your doctor, as biologics can reactivate latent infections,” she cautions. “Some of these medications may worsen or exacerbate chronic medical conditions, so make sure your doctor is updated on all your diagnoses. Some of these medications might increase your risk of certain types of cancers, as well.” Keep up with cancer screenings recommended for people your age, and have a skin check with a dermatologist at least once a year to screen for skin cancers.
Ongoing lab work will likely be required to monitor your overall health, says Migliore, so your doctor knows how your body is responding to the treatment and can catch any side effects or other problems.
Your doctor can help you work through any concerns you may have about your psoriatic arthritis, its treatment, and your overall health, and should be the first person you call if you start experiencing side effects. If one medication isn’t working for you, another might. The good news: There are plenty of options available for treating psoriatic arthritis, and relief is possible, once you find the treatment plan that is right for you.
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