9 Ways to Treat Psoriatic Arthritis
When it comes to your health, more options are almost always better than less. But in the case of psoriatic arthritis (PsA), the sheer number of treatment choices can be overwhelming. How do you know which one will work? Answer: Everyone is different and figuring out the best approach might take some trial and error. For more in-depth advice on how various meds work, check out what the experts have to say.
Before discussing specific meds, tell your doctor what you hope to get out of treatment. “Most often when we ask people with PsA about their goal, it’s to 'get better,'” says Stanford Shoor, M.D., a rheumatologist at Stanford Health Care. But “better” can mean many things, from reducing stiffness to improving skin lesions to being physically active at a high level. The best treatment option is the one that helps you reach your definition of better.
Finding the Right Fit
After you’ve been taking a new drug for a few months, your doctor will check in to see if you’re responding to the medication or experiencing side effects (all PsA meds have some secondary effects), says Dr. Shoor. If a treatment isn't working or it's causing you to feel ill, your doctor will suggest an alternative—likely drawing from one of these nine common treatment types for psoriatic arthritis.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, are typically used to treat mild psoriatic arthritis, says Dr. Shoor. They work by reducing inflammation and may be useful short-term to manage PsA flares. Large doses of NSAIDs over an extended period of time can cause stomach pain, ulcers, and kidney problems, so if you’re relying heavily on NSAIDs, talk to your doctor about changing things up.
Your doctor may suggest corticosteroids—often just called steroids—to treat a bad flare. These drugs reduce inflammation by tempering the immune system. Doctors shy away from prescribing steroids long-term because of side effects like bone loss and high blood pressure, says rheumatologist Anand A. Kumthekar, M.D., an assistant professor at the Albert Einstein College of Medicine. But for a short duration they’re successful at treating symptoms.
For moderate to severe psoriatic arthritis, your doc may suggest a class of drugs known as disease-modifying anti-rheumatic drugs (DMARDs). Rheumatrex (methotrexate) is the most common one, along with Azulfidine (sulfasalazine) and Arava (leflunomide), says Dr. Shoor. They’re taken orally and work by suppressing enzymes that play a role in launching the body’s immune response.
Biologics, a subcategory of DMARDs, are made from whole cells, enzymes, antibodies, and other natural elements. A step beyond traditional DMARDs, these drugs target specific parts of the body involved in the immune response, blocking signals to reduce inflammation. "Taking a biologic along with a DMARD tends to work better than using one alone.” says Dr. Shoor.
Biologics: TNF-Alpha Inhibitors
One type of biologic, TNF-alpha inhibitors, works by suppressing the body’s response to tumor necrosis factor (TNF), a protein produced by white blood cells. People with rheumatic conditions have higher levels of TNF in the blood, which leads to excess inflammation. By controlling TNF levels, these drugs decrease inflammation and keep symptoms of psoriatic arthritis at bay. Brand names include Remicade, Enbrel, Humira, Cimzia, and Simponi.
Biologics: T-Cell Inhibitors
Orencia (abatacept) is a T-cell inhibitor, a type of biologic that works by blocking white blood cells known as T-cells from activating the body’s immune response. T-cells tell your body that it’s time to attack an invader, launching a full-fledged assault that increases inflammation. By blocking these cells, T-cell inhibitors reduce the immune response and associated sweling and stiffness of PsA.
IL-17 and IL-12/23 Inhibitors
Biologics known as IL-17 (interleukin-17) inhibitors, including Cosentyx, Siliq, and Taltz, reduce inflammation by blocking the protein interleukin-17, a main driver of psoriasis. Preventing IL-17 from activating can ease PsA symptoms.
Biologic Stelara (ustekinumab) is an IL-12/23 inhibitor that specifically targets interleukin-12 and interleukin-23, two proteins associated with psoriatic inflammation.
New Oral Medications
Oral med Otezla (apremilast) works by inhibiting an important enzyme, phosphodiesterase 4 (PDE4), that is responsible for controlling inflammatory actions within the body’s cells.
Other oral meds, Xeljanz and Xeljanz XR (tofacitinib), are types of JAK-inhibitors, meaning they act on Janus kinases, a family of enzymes involved in immune system signaling.
What to Know About Insurance
One of the biggest challenges in your PsA treatment may be getting insurance approval. Most insurance companies require you to first try and “fail” a cheaper drug before they’ll pay for something more expensive like a biologic, says Dr. Shoor. What is or isn’t covered varies by insurer. Talk with your doctor’s billing department about any questions or concerns you have; they may be able to help you get coverage for the medications you need.
- NSAIDs: Side Effects and Solutions: Arthritis Foundation. (n.d.). "NSAIDS." arthritis.org/living-with-arthritis/treatments/medication/drug-types/nsaids/side-effects-solutions.php
- Corticosteroids: The Psoriasis and Psoriatic Arthritis Alliance. (n.d.). "Corticosteroids." papaa.org/learn-about-psoriasis-and-psoriatic-arthritis/just-diagnosed/what-is-psoriatic-arthritis/treatments-for-psoriatic-arthritis/corticosteroids/
- TNF Inhibitors (1): American College of Rheumatology. (2019). "TNF Inhibitors." rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/TNF-Inhibitors
- TNF Inhibitors (2): US Food and Drug Administration. (2015). "Information on Tumor Necrosis Factor (TNF) Blockers (marketed as Remicade, Enbrel, Humira, Cimzia, and Simponi)." fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/information-tumor-necrosis-factor-tnf-blockers-marketed-remicade-enbrel-humira-cimzia-and-simponi
- PsA and IL-17: Clinical Reviews in Allergy & Immunology. (2018). "The Immunologic Role of IL-17 in Psoriasis and Psoriatic Arthritis Pathogenesis." link.springer.com/article/10.1007/s12016-018-8702-3
- Biolgics: National Psoriasis Foundation. (2019). "Moderate to Severe Psoriasis and Psoriatic Arthritis: Biologic Drugs." psoriasis.org/about-psoriasis/treatments/biologics
- Oral Treatments: National Psoriasis Foundation. (2019). "New Oral Treatments." psoriasis.org/about-psoriasis/treatments/oral-treatments
- JAK-Inhibitors: Annals of the Rheumatic Diseases. (2013). "Janus kinase Inhibitors in autoimmune diseases." ncbi.nlm.nih.gov/pmc/articles/PMC3616338/