But if your medication stops working or isn’t working as well as it used to, don’t keep quiet. The sooner you bring this to your doctor’s attention, the sooner you can make adjustments to your treatment plan and get back on track.
Making Sense of Psoriatic Arthritis Medications
Early diagnosis and treatment is key to controlling your psoriatic arthritis and preventing disease progression. Psoriatic arthritis treatment options include:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Your doctor might first recommend NSAIDs, such as ibuprofen and naproxen, to help control inflammation, pain, and stiffness when they occur.
Corticosteroids
Your doctor may prescribe a corticosteroid from time to time to help you find relief during a flare. However, these drugs are often used only if necessary, due to the risk of serious side effects.
Traditional disease-modifying anti-rheumatic drugs (DMARDs)
These drugs suppress an array of inflammatory pathways in the body to help control psoriatic arthritis. Options include sulfasalazine, methotrexate, and leflunomide, among others. Some people benefit from a combination of these drugs.
Biologics
This newer class of disease-modifying agents each target a specific protein in the immune response that promotes inflammation. Examples include adalimumab, etanercept, and secukinumab, among others. “The biologic drugs have revolutionized treatment of inflammatory arthritis and typically help to prevent damage and disability if the disease is recognized and treated early,” says Bernadette C. Siaton, MD, a rheumatologist and assistant professor of medicine in the division of rheumatology and clinical immunology at the University of Maryland School of Medicine in Baltimore. However, one 2018 review noted that as many as one in four people who take biologics for psoriatic arthritis still experience moderate to high disease activity, meaning they simply are not getting the right treatment for their condition.
PDE4 Inhibitor
This newer type of oral medication works by selectively targeting small molecules inside immune cells to correct the overactive immune response that causes inflammation related to psoriasis and psoriatic arthritis. For now, the only approved phosphodiesterase 4 (PDE4) inhibitor approved for psoriatic arthritis is apremilast.
JAK Inhibitors
Another group of medications that can be taken orally are Janus kinase (JAK) inhibitors, which inhibit the activity of enzymes that cause inflammation. There are currently two JAK inhibitors approved for treating psoriatic arthritis — tofacitinib and upadacitinib — though even more are under investigation. One 2021 study found that people who don’t respond well to at least one type of biologic tend to have more a favorable treatment response with a JAK inhbibitor (upadacitinib, specifically).
Surgery
In some cases, you may need surgery to replace damaged joints. But with advances in psoriatic arthritis treatment, surgical procedures are becoming less common.
Other Treatment Considerations
If you also have psoriatic arthritis, your treatment plan may include other options to get skin symptoms under control, such as topicals or phototherapy.
Tailoring Treatment to You
Each person’s experience with psoriatic arthritis is different, and so is their response to treatment. Some people who have mild psoriatic arthritis may do well with NSAIDs, while others may require disease-modifying medication to feel well enough to carry out daily activities. Meanwhile, finding the right treatment regimen to best manage your condition can take some trial and error. If one medication or combination of medications isn’t cutting it, you and your doctor may reevaluate to determine if you’d benefit from a treatment change. When might you need to move from one treatment option to another or add a medication to your regimen? As a general rule, persistent symptoms of fatigue, stiffness, joint swelling, or pain are signs that your treatment plan isn’t working. So it’s essential to call your doctor if you continue to have symptoms, if symptoms return, or if they get worse.
What to Expect When Changing Psoriatic Arthritis Treatments
When your treatment plan needs to be adjusted, your doctor may use one of the following strategies. Find out how long you’ll need to wait to see whether a new or additional medication is working for you. It may take up to three months for you to feel the full benefits of a new drug. If you’re not satisfied with how well your treatment is working, talk to your doctor. Ask to run through all of your options, including the latest treatments approved by the Food and Drug Administration (FDA). Another option to consider is joining a clinical trial. If you are eligible, you might be able to try a promising new treatment option before it’s available to the general public. Check www.clinicaltrials.gov to search for trials that are actively recruiting people who have psoriatic arthritis.
