In the past, PsA was primarily treated with injectable and oral prescription drugs. However, these drugs don’t always work. They can also cause uncomfortable side effects. Because of this, a new generation of drugs called biologics is being used to treat moderate to severe PsA.
Biologics are powerful, target-specific drugs. They act by blocking specific inflammatory pathways that play a role in psoriasis.
In the past, biologics weren’t used unless other treatments weren’t effective. Nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs) were likely to be prescribed first.
But new guidelines recommend using biologics as a first-line treatment for PsA. Depending on your psoriatic arthritis symptoms and medical history, your doctor may recommend one of several biologics for relief.
It’s recommended that tumor necrosis factor inhibitor (TNFi) biologics be used as a first-line therapy option in people with active PsA, meaning PsA that’s currently causing symptoms.
New guidelines from the American College of Rheumatology and National Psoriasis Foundation also recommend trying TNFis first in people who haven’t used other treatments before.
Your individual treatment plan will likely be determined by how severe your PsA is. There is no reliable method for figuring out how severe PsA is on its own. Your doctor will likely classify how severe your PsA is based on how severe your psoriasis is. Two ways doctors measure the severity of psoriasis include the indexes below.
Psoriasis Area and Severity Index (PASI)
The PASI score is determined by the percentage of your skin affected by psoriasis. This is based on how much of your body has plaques. Plaques are patches of raised, scaly, itchy, dry, and red skin.
Your doctor will determine your PASI score before and during treatment. The goal of treatment is to see a 50 to 75 percent reduction in your PASI score.
Dermatology Quality of Life Index (DQLI)
The DQLI assessment checks for the effect of psoriasis on a person’s physical, psychological, and social well-being.
A DQLI score of 6 to 10 means that your psoriasis has a moderate impact on your well-being. A score greater than 10 means the condition has a severe effect on your well-being.
Your doctor may also decide you’re eligible for biologics if you have peripheral or axial psoriatic arthritis.
Peripheral psoriatic arthritis
Peripheral psoriatic arthritis causes inflammation of the joints in your arms and legs. These include:
The specific biologic you’re prescribed depends on the severity of your symptoms. But infliximab (Remicade) or adalimumab (Humira) are the preferred choice when you also need fast control of skin psoriasis.
Axial psoriatic arthritis
Axial psoriatic arthritis causes inflammation of the joints in the following places:
Not everyone is eligible for treatment with biologics. For example, you shouldn’t take biologics if you’re pregnant or breastfeeding. In most cases, you also shouldn’t take biologics if you have:
- a serious or active infection
- HIV or hepatitis, unless your condition is well-controlled
- cancer any time in the past 10 years
If biologics aren’t the right choice for you, your doctor may consider other medications, like disease-modifying antirheumatic drugs (DMARDs).
Getting treatment for PsA can bring you needed relief from painful symptoms. Biologics are strong medications that can help treat PsA. They may be an option for you if you have moderate to severe PsA, peripheral psoriatic arthritis, or axial psoriatic arthritis.
Be sure to tell your doctor about all of your symptoms and how PsA affects your life. Your doctor will work to find the right treatment for you.