Psoriatic arthritis (PsA) is a chronic condition, and ongoing treatment is needed to prevent permanent joint damage. The right treatment can also ease the number of arthritis flare-ups.
Biologics are just one type of medication used to treat PsA. These work by suppressing your immune system so it stops attacking healthy joints and causing pain and damage.
Biologics are subtypes of disease-modifying antirheumatic drugs (DMARDs). DMARDs stop your immune system from causing the inflammation of PsA and other autoimmune conditions.
Reducing inflammation has two main effects:
- There may be less pain because inflammation at the joint sites is the root cause of joint.
- Damage may be minimized.
Biologics work by blocking immune system proteins that produce inflammation. Unlike some DMARDs, biologics are administered by infusion or injection only.
Biologics are prescribed as a first-line treatment for people with active PsA. If the first biologic you try doesn’t relieve your symptoms, your doctor can switch you to a different drug in this class.
Four types of biologics are used to treat PsA:
- tumor necrosis factor-alpha (TNF-alpha) inhibitors: adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi Aria), infliximab (Remicade)
- interleukin 12/23 (IL-12/23) inhibitors: ustekinumab (Stelara)
- interleukin 17 (IL-17 inhibitors): ixekizumab (Taltz), secukinumab (Cosentyx)
- T cell inhibitors: abatacept (Orencia)
These drugs either block specific proteins that signal your immune system to attack healthy cells, or they target immune cells involved in the inflammation response. The goal of each biologic subtype is to prevent the inflammatory process from starting.
Several biologics are available. The following are the most commonly prescribed for PsA.
Abatacept (Orencia) is a T cell inhibitor. T cells are white blood cells. They play a role in the immune response, and in triggering inflammation. Orencia targets T cells to bring down inflammation.
Orencia also treats rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). It’s available as an infusion through a vein, or as an injection you give yourself.
Adalimumab (Humira) works by blocking TNF-alpha, a protein that promotes inflammation. People with PsA produce too much TNF-alpha in their skin and joints.
Humira is an injectable medication. It’s also prescribed for Crohn’s disease and other forms of arthritis.
Certolizumab pegol (Cimzia) is another TNF-alpha drug. It’s designed to treat aggressive forms of PsA, as well as Crohn’s disease, RA, and ankylosing spondylitis (AS).
Cimzia is given as a self-injection.
Etanercept (Enbrel) is also a TNF-alpha drug. It’s among the oldest approved drugs for the treatment of PsA, and it’s used to treat other forms of arthritis.
Enbrel is self-injected one to two times per week.
Golimumab (Simponi) is a TNF-alpha drug designed to treat active PsA. It’s also prescribed for moderate-to-severe RA, moderate-to-severe ulcerative colitis (UC), and active AS.
You take Simponi once a month via self-injection.
Infliximab (Remicade) is an infusion version of a TNF-alpha medication. You get the infusion at a doctor’s office three times during six weeks. After the initial treatments, infusions are given every two months.
Remicade also treats Crohn’s disease, UC, and AS. Doctors may prescribe it for RA, together with methotrexate.
Ixekizumab (Taltz) is an IL-17 inhibitor. It blocks IL-17, which is involved in the body’s inflammatory response.
You get Taltz as a series of injections under the skin every two weeks, and then every four weeks.
Secukinumab (Cosentyx) is another IL-17 inhibitor. It’s approved for treating psoriasis and PsA, as well as AS.
You take it as a shot under your skin.
Ustekinumab (Stelara) is an IL-12/23 inhibitor. It blocks the proteins IL-12 and IL-23, which cause inflammation in PsA. Stelara is approved to treat active PsA, plaque psoriasis, and moderate-to-severe Crohn’s disease.
Stelara comes as an injection. After the first injection, it is administered again after four weeks, and then once every 12 weeks.
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 (OTC) 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.
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 a developing baby aren’t quite understood, there is the possibility of complications with pregnancy. Depending on the severity of PsA, some doctors recommend stopping treatment during pregnancy.
Biologics bring hope for many with PsA. Not only do biologics help to manage PsA symptoms, 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.