If your psoriatic arthritis (PsA) is moderate to severe, and other treatments haven’t helped, your doctor may want to prescribe an injectable treatment such as a biologic.
Many people with psoriatic arthritis develop joint damage over time. In this case, an injectable biologic may be the best option, as it could prevent further damage to joints and even put your disease into remission.
It’s important to learn about and understand these treatments before beginning them. Here are a few questions to ask your doctor before starting an injectable treatment for psoriatic arthritis.
There have been many new drug approvals for psoriatic arthritis in recent years, so you should spend some time with your doctor discussing your options.
Injectable treatment means that the drug will be administered directly into your body, as opposed to an oral route, in which the medication is taken by mouth and digested.
Basically, there are two ways injectables are administered:
- intravenous (IV) infusion, which delivers the medicine directly into a vein through a small plastic tube
- needle injection into a muscle, which is an intramuscular (IM) injection, or into skin tissue, which is a subcutaneous (SQ) injection
Methotrexate (Otrexup, Rasuvo, Trexall) is one of the most commonly prescribed medications for psoriatic arthritis. Methotrexate is part of a drug class known as disease-modifying antirheumatic drugs (DMARDs). It can be taken by mouth, which is the more common method, but it can also be administered by injection.
A doctor may want to try methotrexate before moving on to more targeted therapies called biologics, or they may prescribe methotrexate along with a biologic agent.
There are many injectable biologic medications currently approved for psoriatic arthritis, including:
- adalimumab (Humira)
- certolizumab (Cimzia)
- etanercept (Enbrel, Erelzi)
- golimumab (Simponi)
- infliximab (Remicade, Inflectra, Renflexis)
- ustekinumab (Stelara)
- ixekizumab (Taltz)
- secukinumab (Cosentyx)
Ask your doctor to review the similarities and differences between each of these medications. If your doctor already has a particular biologic in mind, ask them their reasons for choosing that one first.
Each of the injectable biologics have different dosing regimens, including by IV infusion, intramuscular injection, or subcutaneous injections. Some are given once or twice a week, while others are infused once a month.
Infliximab, for example, is dosed as three intravenous infusions during the first six weeks and then one infusion every six to eight weeks after that.
Ask your doctor about the different doses for each biologic. When making a decision, consider your personal preferences as well as your schedule.
An IV infusion can seem overwhelming and scary. Ask your doctor what the process will be like, including how long it will last and what it will feel like.
Most of the biologic options come in a pre-filled syringe that you can inject yourself with at home subcutaneously. Ask your doctor if they recommend one of these medications. You’ll need training to learn the proper technique for preparing and injecting the solution.
Many of the biologic agents for psoriatic arthritis target your immune system, decreasing your body’s ability to fight off infections. Because of this, you’ll need frequent testing and monitoring to make sure that you don’t have any infections.
Before taking any biologics, you’ll be tested for tuberculosis, HIV, hepatitis, and other bacterial or fungal infections. You may need to get a vaccine against hepatitis B and tuberculosis before you start taking a biologic.
Your doctor will likely also need to check your liver function and blood count. Ask your doctor how often you’ll need to come in for a blood test if you start a biologic.
All the medications that treat psoriatic arthritis can cause side effects. Whether or not you’ll experience side effects, it’s still important to assess the pros and cons of the drug with your doctor.
Some of the most common side effects of biologic agents include:
- upper respiratory infections
- increased risk of mild to serious infections
- swelling, pain, or rash at the injection site
- stomach pain
The most common side effects of methotrexate include:
- mouth sores
- trouble sleeping
- liver damage
You may begin to notice some improvement after the first or second injection and a bigger improvement within four to six weeks. Before you begin an injectable treatment, ask your doctor what you can reasonably expect in terms of how soon you’ll feel better.
Some biologics can help you achieve remission. Talk your doctor about the treatment that will give you the best chance of this.
Most rheumatologists recommend that you continue biologic therapy even if your symptoms disappear. It’s important to remember that while injections often work well, they don’t cure the underlying disease. Your doctor can give you a more definitive answer.
Your insurance may only cover some of the biologic agents for psoriatic arthritis. In general, the drug you receive is usually determined by which medication your insurance provider prefers. You may need to complete paperwork or pay a higher co-pay to get insurance coverage for others.
Ask your doctor’s office for confirmation from your insurance company that they cover the injectable that you choose.
You can request information about co-pay assistance from your doctor. The pharmaceutical company that makes your chosen brand may also provide a financial assistance program.
If you take an injectable and your symptoms don’t improve, or your side effects are too severe, your doctor might want to switch you to a different type of biologic.
Ustekinumab, for example, isn’t usually prescribed unless your symptoms don’t improve from TNF inhibitors (like adalimumab or etanercept) or if you experience severe side effects.
The aim of injectable medications includes both symptom management and preventing permanent joint damage.
Ultimately, the injectable your doctor prescribes depends on your particular condition. It also depends on your insurance coverage and your preference for how often you'll need infusions.
Biologics target your immune system, which puts you at a higher risk of serious infections. Talk to your doctor about the risks and benefits of injectable treatments.