Psoriatic arthritis, or PsA, causes swelling, stiffness, and joint pain. There is no cure for PsA. People living with the condition turn to medications to manage their symptoms. The usual go-to medications are nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs).
More recently, a class of drugs called biologics is giving new hope to those living with moderate to severe PsA. Although biologics are not new, they offer more advanced therapy now than ever before.
What are biologics?
Traditional medications consist of synthetic components. They’re made from chemicals not found in nature. Common drugs that people know and trust are created in a laboratory setting from nonbiological materials. Aspirin, for example, was modeled after a substance in willow bark, but is now made from synthetic materials.
Biologics, on the other hand, are made up of biological components. Scientists use whole cells, enzymes, antibodies, and other elements to create a drug with a very specific function.
Because biologics are more precise when targeting cells, and mimic molecules found naturally in the body, they are generally more effective. They also have fewer side effects than drugs made from chemicals.
If this sounds a little too scientific, don’t fret. Chances are you’ve already been exposed to medical technology made from components found in nature. If you’ve ever had a vaccine or received a blood transfusion, you’ve had a medical treatment that was created based on biological materials.
How are biologics used to treat PsA?
Inflammation typically causes the swelling, stiffness, and joint pain that defines PsA. Biologics used to treat PsA specifically target different pathways in the body that create inflammation. This is different from traditional drugs, which target many steps in the immune system.
Depending on your psoriatic arthritis symptoms and medical history, your doctor may recommend one of several biologics for relief.
What are my options to treat PsA with a biologic?
You have many potential options to treat your PsA with a biologic. The National Psoriasis Foundation lists a dozen biologics suitable for PsA, psoriasis, or both. These drugs can be grouped together by your doctor based on how they act in relation to the immune system.
Tumor necrosis factor-alpha (TNF-alpha) is a protein that leads to inflammation. People with PsA have excessive amounts of TNF-alpha on their skin or in their joints. Five different drugs — Cimzia, Enbrel, Humira, Remicade, and Simponi — are designed to block this protein. They work by stopping the excessive growth of skin cells and inflammation that can lead to damage of joint tissue.
IL-12/23, IL-23, and IL-17 inhibitors
Interleukin-12, interleukin-17, and interleukin-23 are different proteins associated with inflammation. Five biologics currently available will interfere with the activity or with the corresponding receptor of these proteins. Specifically, Stelara (IL-12/23), Cosentyx (IL-17), Taltz (IL-17), Siliq (IL-17), and Tremfya (IL-23) prevent inflammation in people living with PsA or psoriasis.
In people who have arthritis, T-lymphocyte cells, or T-cells, are activated, which can lead to a proliferation of these cells. Some people with arthritis will actually develop an excess of T-cells. These are immune cells, which we all need. But in large amounts, they produce chemicals that lead to joint damage, pain, and swelling. Orencia doesn’t reduce the number of T-cells, but it does stop the emission of the chemical that causes symptoms by blocking T-cell activation.
JAK kinase inhibitor
Xeljanz (tofacitinib) is another medication approved for PsA. It’s a JAK kinase inhibitor, which refers to a small molecule that blocks a pathway involved in the immune system’s inflammation response. This medication is not technically a biologic, but your doctor may talk to you about it. It’s often grouped together with biologics in discussions about newer, more targeted agents for autoimmunity.
Are biologics an option for everyone with PsA?
Biologics are for those living with moderate to severe PsA. Your doctor first may opt for NSAIDs and then DMARDs before considering a biologic. If these treatments don’t relieve your symptoms or cause severe side effects, you may be a candidate for the treatment.
Some people aren’t candidates for biologics. That’s because the drug’s side effects may do more harm than good. People with compromised immune systems or active infections shouldn’t take biologics for their PsA. The cost and out-of-pocket expenses for biologics can also be a barrier for some people.
What are the side effects of taking a biologic?
Each PsA biologic is different. Each has its own potential side effects. However, there are also similarities in this class of drugs. The most common side effect for all biologics is an increased risk of unusual, or opportunistic, infections.
If you and your doctor decide to try this course of treatment with a biologic, you may experience flu-like symptoms or respiratory infections. Since biologics are given by injection or IV, you may also experience discomfort where the needle pokes your skin.
Biologics may also lead to more serious side effects, such as blood disorders or cancer. For these reasons, it’s always a good idea to develop a strong relationship with your doctor. Together, you can decide on whether a biologic is a way forward for you to lessen or prevent joint destruction from psoriatic arthritis.
Biologics have introduced targeted treatment options for those living with moderate to severe PsA. Not all are new, but they do offer more advanced therapy for people who have PsA. If you feel that your current treatment plan isn’t working anymore, it may be worthwhile to talk to your doctor about biologics.