Advances in Psoriatic Arthritis Treatment
Psoriatic arthritis is a type of inflammatory arthritis associated with psoriasis, a disease that affects skin and nails. It’s classified as an autoimmune disease, meaning the body’s immune system mistakenly attacks healthy cells, causing pain and inflammation. Symptoms of psoriatic arthritis include swollen fingers, scaly skin, lower back pain and stiffness, and joint damage.
Early and effective treatment is essential to preventing long-term problems caused by psoriatic arthritis. The goal of a treatment plan is disease remission or the reduction of symptoms and prevention of long-term damage and a decreased ability to function. Advanced treatment options such as biologics and other new medications make it possible for people with psoriatic arthritis to experience symptom-relief and possibly remission of the disease.
Biologic agents, or biologics, are protein-based drugs derived from human genes that have changed the treatment of skin and joint disease. This class of drugs targets specific proteins in the body that cause inflammation. They can be more effective in treating both psoriasis and psoriatic arthritis than other medications available.
The first biologic medications targeted an inflammatory-causing substance called tumor necrosis factor (TNF). Over the past several years’ researchers have discovered other molecules that trigger inflammatory responses in the body. These discoveries have led researchers to develop new treatments to successfully block these other molecules. It’s important to note that after several years, a biologic medication may lose its effectiveness in some patients. But now, with new medications that target different disease-activating molecules, we have useful alternatives to successfully treat patients. These newer drugs include:
This biologic medication, approved by the U.S. Food and Drug Administration (FDA) in 2013 to treat psoriatic arthritis, blocks interleukin 12 (IL-12) and interleukin 23 (IL-23). Also called an IL-12/23 inhibitor, the drug is administered by subcutaneous (under the skin) injection by a healthcare provider every three months. It was approved by the FDA for psoriasis in 2009. People take it alone or in combination with other medications.
This new medication is helpful because it’s effective in treating both the joint inflammation and the skin condition. Also, in September 2016, the FDA approved ustekinumab to treat Crohn’s disease, which is a condition sometimes associated with psoriatic arthritis.
Side effects may include bruising at injection site, upper respiratory infection, headache, and fatigue. And because ustekinumab suppresses your immune system, it can increase your risk for infections and certain cancers.
Approved in 2016 to treat psoriatic arthritis, secukinumab is the newest medication to be added to the list of treatment options. A doctor injects this drug under the skin. It works by blocking the interleukin 17 (IL-17) inflammatory molecule. Secukinumab was approved in 2015 to treat psoriasis and in 2016 to treat ankylosing spondylitis (spinal arthritis). Like TNF inhibitors, which include etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade), this drug is also approved to treat these three conditions, which are often associated with each other.
Side effects may include cold symptoms, upper respiratory infection, and diarrhea. Secukinumab also suppresses your immune system and may increase your risk for infections. It may also cause Crohn’s disease flare-ups. Long-term safety data are currently being collected.
Apremilast, approved in 2014 to treat psoriatic arthritis, attacks an enzyme called phosphodiesterase 4 (PDE4) that causes inflammation. The medication was also FDA approved in 2014 to treat psoriasis. It’s not a biologic; it is a small-molecule targeted therapy. This type of treatment helps prevent inflammation by interrupting cell activity. It’s administered in pill form and is the first oral medication in the U.S. approved to treat psoriatic arthritis.
This medication differs from biologics because it does not suppress the immune system to the same extent and therefore does not carry the same risk for infection. Side effects can include diarrhea and nausea, weight loss, headaches, fatigue, and depression.
Talk to Your Doctor
We have more options than ever now to treat psoriatic arthritis. These new drugs help people with psoriatic arthritis reduce pain, inflammation, and skin and musculoskeletal flare-ups. If your prescribed treatment is not helping eliminate or reduce your psoriatic arthritis symptoms, you need to tell your doctor. Psoriatic arthritis can change course over time, and different symptoms can appear. Doctors need to adapt treatments to make sure they target all symptoms continuously. Consult with your physician to decide the best treatment option for you and your psoriatic arthritis.
*This article is not an endorsement of any particular drug, but rather a description of the new drugs available to patients. Please consult with your physician to decide the best treatment options.