Medication for Psoriatic Arthritis
In recent years, there have been many advances in managing psoriatic arthritis. NYU Langone rheumatologists may prescribe medications to alleviate symptoms, preserve joint function, and prevent joint damage. These medications help some people achieve remission, in which a person experiences no symptoms of the condition.
Many people who have psoriatic arthritis already have psoriasis and may be taking medication to manage the symptoms of that skin condition. Your doctor takes this into account when determining which therapy is right for you, ensuring that you’re taking the most appropriate medications for the management of both psoriasis and psoriatic arthritis.
In some cases, a combination of medications may be used to treat people with psoriatic arthritis. Your doctor monitors your response to these medications and adjusts the prescription type or strength, if necessary.
Rheumatologists often prescribe nonsteroidal anti-inflammatory drugs, also known as NSAIDs, to people with psoriatic arthritis. These medications can help ease pain and curb the swelling that accompanies this condition.
Common NSAIDs include aspirin, ibuprofen, and naproxen. These medications do not treat the underlying cause of the inflammation in people with psoriatic arthritis, nor do they prevent joint damage.
People with mild psoriatic arthritis tend to respond well to NSAIDs and may not need to take any other medications. If symptoms worsen, they may need more aggressive therapy.
For the best results, doctors suggest taking the same dose of these medications consistently for a few weeks. They also recommend limiting their use, because the medications can sometimes lead to heartburn, vomiting, or bleeding in the stomach. Your doctor recommends the most appropriate dosage and frequency based on your symptoms.
Disease-Modifying Antirheumatic Drugs
Disease-modifying antirheumatic drugs are the most commonly prescribed medications for the treatment of psoriatic arthritis. They slow the progression of the disease by shutting down parts of the inflammatory cascade—the process by which inflammation spreads throughout the body—and preventing inflammation from damaging the joints and skin.
Most people with the condition experience relief after taking these medications. This may take several weeks to months to occur, depending on the medication.
Your doctor may prescribe one of these medications or a combination of two, depending on how your body responds. Different types of disease-modifying antirheumatic drugs have different side effects. Your doctor discusses these with you and takes this into account when deciding which medication is best for you.
Methotrexate is the most commonly prescribed medication of this type. A new medication, called apremilast, was approved by the U.S. Food and Drug Administration in 2014 for treating psoriatic arthritis.
Biologic Response Modifiers
Biologic response modifiers, also known as biologics, comprise the newest class of psoriatic arthritis medications. They are designed for people with moderate to severe psoriatic arthritis.
Most of these medications work by blocking tumor necrosis factor, a protein that causes joint inflammation. Biologics can be prescribed on their own or, for people with severe symptoms, in conjunction with a disease-modifying antirheumatic drug.
Commonly prescribed biologics for psoriatic arthritis include etanercept, adalimumab, golimumab, certolizumab pegol, and infliximab.
A biologic known as ustekinumab, which does not block tumor necrosis factor, may also be prescribed. It can be taken alone or in combination with methotrexate. It is prescribed for both psoriatic arthritis and psoriasis.
Most biologics are given by injection, anywhere from once a week to once every few months. For instance, etanercept is injected weekly, whereas ustekinumab is administered as an injection every 4 weeks in the beginning of treatment and every 12 weeks thereafter. Your doctor or nurse can teach you how to inject the medication at home.
Other biologics, such as infliximab, are administered through a vein with intravenous (IV) infusion at a doctor’s office every six to eight weeks. Treatment can take up to three hours. You may read, rest, or watch television while receiving the infusion.
These medications may affect your body’s ability to fight infection. Your doctor asks about your medical history before beginning treatment and carefully monitors you during treatment to prevent any complications.
These medications, which are also called steroids, help to reduce inflammation. Steroids are occasionally prescribed to treat severe flare-ups of symptoms.
Doctors may inject steroids directly into joints to limit the side effects associated with long-term oral steroid use. These side effects may include weight gain and osteoporosis.