An Overview of the Most Commonly Prescribed Medications for PsA

There is currently no cure for PsA, but there are plenty of medications that can help you manage your symptoms.

Psoriatic arthritis (PsA) is a type of inflammatory arthritis that develops in about 30% of people with psoriasis. Common symptoms of PsA include skin plaques, swelling, stiffness, and joint pain.

Medications and lifestyle changes like modified diet plans can help manage symptoms and slow disease progression.

There are several commonly prescribed medications for PsA. What type your doctor prescribes will depend on your symptoms, condition severity, and other health factors.

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NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used as needed to manage inflammation and pain. Many — such as ibuprofen and naproxen — are available over the counter, though some are prescribed.

While NSAIDs target pain and swelling, they don’t treat PsA itself or improve skin plaques.

Steroids

Similar to NSAIDs, steroids only help manage symptoms of pain and inflammation. They don’t change the course of the disease.

The most commonly prescribed corticosteroids are prednisone and methylprednisolone. They’re available by prescription only.

There are times when it may be necessary to take steroids, but generally, they’re not ideal for long-term use.

DMARDs

Disease-modifying antirheumatic drugs, or DMARDs, suppress inflammation by suppressing the immune system. They slow joint damage and the progression of PsA.

While they’re not very targeted therapies, they are easily accessible and often cost-effective.

The most common DMARDs for PsA are:

• methotrexate
• leflunomide
• sulfasalazine
• cyclosporine

Biologic medications

Biologic medications are often prescribed to people with moderate or severe PsA. Biologics are more targeted than other treatments. They’re made of living biological components, which give them their name.

Because of the advanced technology that goes into developing and producing biologics, they’re usually the most costly PsA treatment option. It’s estimated that they can cost between $10,000 and $30,000 a year on average.

Like any medication, there are possible side effects with taking biologics. The most common among all types of biologics is an increased risk of infection, including rare infections. Some people also report flu-like symptoms after taking them. If the biologic is an injection, you may feel some pain wherever it was injected.

There are multiple classes of biologics and several medications in each class.

TNF-alpha inhibitors

Tumor necrosis factor-alpha (TNF-alpha for short) is a protein that creates inflammation in the body. People with PsA have excessive amounts of this protein.

Medications in this class are designed to block the TNF-alpha protein which stops the overgrowth of skin and inflammation.

Biologics in this class are:

• certolizumab pegol (Cimzia)
• etanercept (Enbrel)
• adalimumab (Humira)
• infliximab (Remicade)
• golimumab (Simponi)

TNF-alpha inhibitors may have adverse side effects on your heart. If you have a cardiovascular condition, TNF-alpha inhibitors may not be the best type of biologic for you. Talk with a rheumatologist if you have questions or concerns.

IL-12, IL-23, and IL-17 inhibitors

Interleukin-12, interleukin-17, and interleukin-23 are proteins associated with inflammation. Biologics in this class block signals from IL proteins, reducing inflammation and controlling disease progression.

The biologic medications from this class are:

• IL-12/23: ustekinumab (Stelara)
• IL-23: guselkumab (Tremfya)
• IL-17: secukinumab (Cosentyx)
• IL-17: ixekizumab (Taltz)
• IL-17: brodalumab (Siliq)

T-Cell inhibitors

T-lymphocyte cells, or T-cells, are overproduced and overactivated in people with PsA. These normally helpful immune cells can produce harmful waste when there are too many. This waste can worsen joint damage, pain, and swelling.

T-cell inhibitors like abatacept (Orencia) stop T-cell activation, which helps stop T-cells from producing waste. However, it does not affect the number of T-cells in the body.

JAK inhibitors

Janus kinase inhibitors (JAK inhibitors) are small molecules that block pathways in the immune system’s inflammatory response. This helps reduce inflammation in the body and joints.

While JAK inhibitors are not technically biologics, they’re often classified as them because of their targeted treatment of the immune system.

Phosphodiesterase 4 (PDE4) inhibitors

This class of medication blocks the production of an enzyme called phosphodiesterase 4 (PDE4) and reduces inflammation. It’s not normally a first-line choice to limit joint damage, but it may be prescribed if other medications have not worked.

Apremilast (Otezla) is a common PDE4 inhibitor used for PsA.

The takeaway

While there’s currently no cure for PsA, there is always a reason for hope. New research continues to be published and new medications are developed and in testing every day.

Right now, you and your rheumatologist can decide on the best treatment plan for your PsA. Just remember to keep an open line of communication with your treatment team and call them right away if you have any extreme medication side effects or flare ups.