An Overview of Medications for Treating Psoriatic Arthritis

There is currently no cure for psoriatic arthritis (PsA). Medicinal treatment for psoriatic arthritis (PsA) focuses on controlling inflammation to prevent joint damage and disability and includes non-steroidal anti-inflammatory drugs (NSAIDS), different types of disease-modifying anti-rheumatic drugs (DMARDs), biosimilars, and corticosteroids.

Psoriatic arthritis is a type of inflammatory arthritis affecting people with psoriasis, an inflammatory skin condition. Psoriasis speeds up skin cell growth, causing them to build on the surface of the skin. Symptoms of PsA include joint pain, stiffness, and swelling, along with skin lesions associated with psoriasis.

The goal of PsA treatment is to improve skin and joint symptoms. There are many medicinal options for treatment that may include one or more of the following drug therapies.

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NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are pain relievers and, in larger doses, they can decrease inflammation. NSAIDs are effective for people whose PsA is mild.

Some NSAIDs are available over-the-counter (OTC), such as Advil and Motrin, while others require a prescription. Cox-2 inhibitors are generally prescribed for long-term conditions, including PsA, because they are believed to be safer on the stomach. However, recent studies have shown no difference in stomach side effects between NSAIDs and COX-2 inhibitors.

While most people can tolerate NSAIDs, they are not without their side effects, which include:

• Stomach irritation
• Heart problems
• Liver and kidney damage

Traditional DMARDs

Traditional disease-modifying antirheumatic drugs (DMARDs) can help to slow down or even stop the inflammatory process that would otherwise damage joints and eventually lead to disability. 

Traditional DMARDs include:

• Methotrexate
• Sulfasalazine
• Leflunomide
• Antimalarial drugs, such as Plaquenil (hydroxychloroquine).

These medications are also called immunosuppressants because they suppress or reduce the strength of the immune system. 

The most common side effects of traditional DMARDs include:

• Skin rash
• Temporary hair loss
• Gastrointestinal symptoms, including nausea, diarrhea, and abdominal pain
• Weight loss
• Liver damage

Biologic DMARDs

Biologic DMARDs (biologics) are used for moderate to severe PsA when other therapies have not worked. They include medications called TNF inhibitors, which block a substance called tumor necrosis factor (TNF). Too much TNF leads to inflammation.

Biologics used to treat PsA include:

• Cimzia (certolizumab pegol)
• Cosentyx (secukinumab)
• Enbrel (etanercept)
• Humira (adalimumab)
• Orencia (abatacept)
• Remicade (infliximab)
• Simponi (golimumab)

Side effects of these medications include:

• Site injection pain and bruising
• Increased risk for infection
• Nausea
• Diarrhea

Biosimilars

Biosimilars are biologic therapies very similar to already approved biologic drugs. You can recognize them by the way their names are written: Biosimilars have a four-letter suffix after the generic name.

Much like biologic DMARDs, biosimilars may regulate or even reduce inflammatory responses. While they are cheaper than biologic DMARDs, they are not generics of those medications. Moreover, like biologics, they must undergo strict Food and Drug Administration (FDA) testing.

Some biosimilars currently used in PsA treatment include:

• Amjevita (adalimumab-atto), biosimilar to Humira
• Erelzi (etanercept-szzs), biosimilar to Enbrel
• Inflectra (infliximab-dyyb), biosimilar to Remicade

Side effects of biosimilars include:

• Flu-like symptoms
• Headache
• Abdominal pain
• Injection site reaction
• Upper respiratory infection

Target-Specific DMARDs

Currently, the only available target-specific DMARDs are Janus kinase (JAK) inhibitors. JAK is a cytokine (chemical messenger) that researchers believe plays a role in causing inflammation. In PsA and similar conditions, JAK inhibitors can reduce inflammatory responses and halt joint damage that would be a consequence of inflammation.  

Currently, there is only one JAK inhibitor drug available for treating PsA:

• Xeljanz (tofacitinib)

Common side effects of JAK inhibitor drugs include:

• Infections, including upper respiratory infections and urinary tract infections
• Headache
• Cold symptoms (sore throat, runny or stuffy nose, etc.)
• Dizziness
• Headaches
• Bruising
• Weight gain
• Gastrointestinal symptoms (bloating, gas, diarrhea, etc.)
• Low blood platelet levels and/or anemia
• Shortness of breath
• Fatigue

Serious side effects of Xeljanz can include:

• Serious infections
• Blood disorders
• Tears in your digestive tract
• Abnormal liver function tests
• Allergic reactions

There is an increased risk of serious adverse events with the use of Xeljanz:

• Heart-related events, such as heart attack and stroke
• Cancer
• Blood clots
• Death

Corticosteroids

Corticosteroids mimic cortisol, a hormone naturally produced by the body. In doing so, they can reduce inflammation in the body. Corticosteroid is generally injected into affected joints.

A Word From Verywell

Your doctor can determine what medication—or medications—are right for your unique situation. It is important to keep in mind that while PsA medications can decrease pain and skin lesions, they are not a cure, and should be part a comprehensive treatment plan that includes a healthy lifestyle and complementary therapies.