Psoriatic arthritis (PsA) is a chronic (ongoing) condition, and ongoing treatment is a must to prevent permanent joint damage. Furthermore, the right treatment can also ease the number of arthritis flare-ups.
Biologics are just one type of medication used in the treatment of PsA. These work by suppressing your immune system so it stops attacking healthy joints and causing pain and damage.
What are biologics?
Biologics are subtypes of disease-modifying antirheumatic drugs (DMARDs). DMARDs stop your immune system from causing the inflammation of PsA, among other autoimmune diseases. The reduction of inflammation works two-fold. First, patients can experience less pain, because inflammation at the joint sites is the root cause. Also, joint damage may be minimized.
Biologics work specifically by stopping cellular destruction from your immune system. Unlike some DMARDs, biologics are administered by infusion or injection only. These are also primarily used to treat moderate to severe cases of PsA. Biologics aren’t typically used to treat mild cases, due to its effects on your immune system.
Types of biologics
Two types of biologics are used to treat PsA: antitumor necrosis factor-alpha (TNF-alpha) drugs and ustekinumab. Both types block specific proteins that send signals to your immune system to attack healthy cells. The goal of each biologic subtype is to prevent the inflammatory process from starting.
Several biologics are available. The following are the six most commonly prescribed for PsA.
Adalimumab (Humira) is a TNF-alpha drug. It’s an injectable medication. For treating PsA, Humira is given in 40 milligram (mg) doses every other week.
Humira is also prescribed for Crohn’s disease as well as other forms of arthritis.
Etanercept (Enbrel) is another type of TNF-alpha drug. It’s among the oldest approved drugs for the treatment of PsA, and it’s also used in other forms of arthritis.
For PsA, it’s prescribed at 50 mg doses. These are self-injected one to two times per week.
The exact dosage of ustekinumab (Stelara) depends on body weight. Adults weighing more than 220 pounds receive 90 mg injections, while those weighing less take 45 mg doses.
After the initial injection, Stelara is administered again after four weeks. Then, injections are given every 12 weeks.
Certolizumab (Cimzia) is a TNF-alpha drug. For PsA, the initial dose of this medication is two 200 mg injections to start. The same dosage is given at weeks two and four. After that, Cimzia is injected every other week at 200 mg doses.
Cimzia is specifically designed for aggressive forms of PsA, as well as Crohn’s disease and rheumatoid arthritis.
Infliximab (Remicade) is an infusion version of a TNF-alpha medication.
At first, those being treated for PsA receive 5 mg for each kg of body weight. This is done at a doctor’s office three times in the course of six weeks. After the initial treatments, infusions are given every two months.
Golimumab (Simponi) is a TNF-alpha drug designed for moderate to severe PsA. It’s taken just once a month via self-injection. The average dose for PsA is 50 mg. Like other biologics, it’s taken regularly for maximum effect.
For moderate to severe PsA, biologics are essential in managing both short-term and long-term symptoms and complications. However, your doctor may also recommend other treatments.
Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain. These also reduce inflammation. Over-the-counter versions, such as ibuprofen (Advil), are widely available, as well as prescription-strength formulas. Since long-term use can increase the risk of stomach bleeding, heart problems, and stroke, NSAIDs should be used sparingly and at the lowest dose possible.
If you had psoriasis before PsA, then you may also need therapies to help alleviate skin rashes and nail problems. Possible treatment options include corticosteroids, light therapy, and prescription ointments.
Side effects and warnings
The most common side effects of biologics are skin reactions (such as redness and rash) at the site of the injection. Because biologics control your immune system, you may also be at an increased risk for developing infections.
Less common, but serious, side effects include:
- worsening psoriasis
- upper respiratory infection
- lupus-like symptoms (such as muscle and joint pain, fever, and hair loss)
Talk to your rheumatologist about these possible side effects, and monitor your condition carefully. Call right away if you suspect you’re having an adverse reaction to your medications.
Also, women who are pregnant or are planning to become pregnant should use biologics with care. Though the effects on fetuses aren’t quite understood, there is the possibility of complications with pregnancy. Depending on the severity of PsA, some doctors recommend ceasing treatment during pregnancy.
Bottom line: Biologics are one part of a PsA management plan
Biologics have brought hope for many with PsA. Not only do biologics help to manage, but they also decrease the destructive nature of the underlying inflammation.
Still, it’s important to remember that biologics are just one part of your long-term PsA management plan. Talk to your doctor about lifestyle changes and other medications that can help.