Several classes of medications are used to treat psoriatic arthritis. Most require a prescription from a medical professional. Psoriatic arthritis treatments may be taken as a pill, applied topically, injected subcutaneously (beneath the skin), or given as an IV infusion.
The practice of adjusting medications to reach a treatment goal is called “treat to target,” and it’s an approach that’s used to treat rheumatoid arthritis and other inflammatory diseases, according to the Arthritis Foundation.
Using a treat-to-target approach to achieve remission can require frequent doctor visits and many changes in your drug regimen. It’s important to discuss your personal goals and priorities for treatment with your rheumatologist to make sure that you’re on the same page and that you understand what’s involved in reaching those goals.
Nonsteroidal Anti-Inflammatory Drugs
While NSAIDs can help control symptoms of psoriatic arthritis, they don’t prevent joint damage.
Both over-the-counter and prescription NSAIDs are available:
- ibuprofen (Advil, Motrin)
- naproxen (Aleve)
- diclofenac (Arthrotec)
Steroids
Steroids, also known as glucocorticoids, can be used in a few ways in psoriatic arthritis treatment.
They may be injected directly into a joint to reduce pain and stiffness in that joint.
While stopping steroid treatment has long been thought to cause psoriasis flares, recent research suggests that the risk of a psoriatic flare is low.
Disease-Modifying Antirheumatic Drugs
Disease-modifying antirheumatic drugs (DMARDs) work by suppressing inflammation-causing chemicals in the body. They can slow the progression of psoriatic arthritis and prevent permanent joint damage.
Most traditional DMARDs are taken by mouth. It can take a month or more before you’ll know whether a DMARD is working for you.
The following medicines are DMARDs:
- methotrexate (Trexall)
- Leflunomide (Arava)
- sulfasalazine (Azulfidine)
- azathioprine (Imuran, Azasan)
- cyclosporine (Gengraf, Neoral, Sandimmune)
The most commonly used is methotrexate. Azathioprine and cyclosporine are rarely used but may be appropriate in some situations.
JAK Inhibitors
Janus kinase (JAK) inhibitors are a new type of DMARD that blocks certain enzymes that can cause inflammation. They are taken as pills. These JAK inhibitors are approved to treat psoriatic arthritis:
- tofacitinib (Xeljanz)
- upadacitinib (Rinvoq)
Side effects of JAK inhibitors can include nausea, indigestion, diarrhea, headaches, increased risk of upper respiratory tract infections, and increased cholesterol levels. Some of these side effects may decrease over time.
The JAK inhibitors approved for psoriatic arthritis carry warnings about the risks of serious heart-related events, cancer, blood clots, and death associated with these drugs.
Because JAK inhibitors can raise the risk of infections, testing for tuberculosis or other infectious diseases is required before starting treatment. Periodic blood tests for liver function and other measures are also needed while taking the drug.
Phosphodiesterase-4 Inhibitors
Phosphodiesterase-4 (PDE4) inhibitors are another new DMARD. They work by selectively targeting small molecules inside immune cells to correct the overactive immune response that causes inflammation in psoriatic arthritis. They are taken as pills or delivered topically.These medications include apremalist (Otezla).
Side effects seen in clinical trials of apremilast include headache, abdominal pain, depression, weight loss, nausea, diarrhea, vomiting, and upper respiratory tract infections.
Biologics
Biologics target specific cells or proteins of the immune system that play a role in the development of psoriatic arthritis. They can slow or stop the inflammatory processes in the body that lead to joint damage.
The classes of biologics with approved drugs for treatment of psoriatic arthritis include the following:
- Tumor necrosis factor (TNF)–alpha inhibitors
- Interleukin 12 and 23 (IL-12, IL-23) inhibitors
- Interleukin 17A (IL-17A) inhibitors
- Interleukin 17A and 17F (IL-17A and IL-17F) inhibitors
- Interleukin 23 (IL-23) inhibitors
- T-cell inhibitors
The American College of Rheumatology and National Psoriasis Foundation have jointly created guidelines on which biologic to prescribe first, depending on what medications a person has used before, how active their disease is, and what other medical conditions they might have, such as inflammatory bowel disease, which can be treated with some of the same biologics.
If one class of biologics doesn’t control an individual’s psoriatic arthritis symptoms, another might. Only one biologic is prescribed at a time, although doctors may use them in combination with nonbiologics to control symptoms and progression.
All of the biologics are administered as either a subcutaneous injection, which can be taken at home, or as an IV infusion, done in a medical office or hospital infusion center. .
Because biologics can raise the risk of infections, testing for tuberculosis or other infectious diseases may be required before starting treatment with a biologic.
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