What Types of Medicines Are Used to Treat Psoriatic Arthritis?

There are several kinds of medicines used to treat psoriatic arthritis (PsA). They target different things in the body to help reduce inflammation and other PsA symptoms. Inflammation can lead to joint damage and long-term disability, so it is important to treat it.¹

Drug treatments for PsA fall into several categories, including:¹

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Traditional disease-modifying antirheumatic drugs (DMARDs)
• Biologic DMARDs, including target-specific DMARDs
• Biosimilars
• Other drugs

What are NSAIDs?

NSAIDs are commonly used pain medicines that can help decrease inflammation. They can be an effective treatment for mild PsA. While NSAIDs can help reduce joint pain and stiffness, they do not do anything to improve the psoriasis on the skin.^1,2

Some NSAIDs are available over the counter. Others are available only with a prescription. NSAIDs include:²

• Aspirin
• Ibuprofen
• Naproxen
• Other generic and brand-name drugs

Most people tolerate NSAIDs well, but side effects are possible, including heartburn, ulcers, bleeding in the stomach, and kidney problems.²

What are corticosteroids?

Corticosteroids are also called glucocorticoids or steroids. They are drugs that help reduce inflammation in the body. They are used to treat PsA as well as other diseases.^1,3

For people with PsA, corticosteroids are taken by mouth, injected into affected joints, or applied topically. These drugs tend to have many side effects, and some experts do not favor this form of treatment. Talk with your doctor about what is best for you.^1,3

What are traditional DMARDs?

Traditional DMARDs are drugs that slow or stop inflammation. They are usually taken as a pill. Traditional DMARDs include:^1,4,5

• Methotrexate
• Azulfidine® (sulfasalazine)
• Arava® (leflunomide)
• Imuran® (azathioprine)
• Antimalarial drugs such as Plaquenil® (hydroxychloroquine)

What are biologic DMARDs?

Biologic DMARDs are drugs made from living cells. These cells can come from parts of the blood, proteins, viruses, or tissue. This process creates drugs that can prevent, treat, and cure disease.⁶

In people with PsA, biologic DMARDs reduce the immune system’s response. They do this by blocking the action of specific proteins. In this way, they regulate the inflammatory responses that cause PsA symptoms.⁷

Biologic DMARDs target proteins such as tumor necrosis factor (TNF) and certain interleukins (IL). They are usually given as an injection or infusion. Examples of biologic DMARDs include:^7,8

• Cimzia® (certolizumab pegol)
• Cosentyx® (secukinumab)
• Enbrel® (etanercept)
• Humira® (adalimumab)
• Orencia® (abatacept)
• Remicade® (infliximab)
• Simponi® (golimumab)
• Simponi Aria® (golimumab)
• Stelara® (ustekinumab)
• Taltz® (ixekizumab)
• Tremfya® (guselkumab)

What are target-specific DMARDs?

Target-specific DMARDs work by targeting certain enzymes to help reduce the inflammatory response that causes joint pain, swelling, and stiffness. Target-specific DMARDs used to treat PsA include:^4,6

• Otezla® (apremilast)
• Xeljanz® (tofacitinib) and Xeljanz XR® (tofacitinib)
• Rinvoq® (upadacitinib)

Otezla is an oral phosphodiesterase 4 (PDE4) inhibitor. PDE4 inhibitors suppress parts of the immune response, such as cell recruitment and activation of inflammatory cells.⁴

Xeljanz and Rinvoq are Janus kinase (JAK) inhibitors. JAK is a type of cytokine or chemical messenger. It is believed to play a role in inflammation.⁴

What are biosimilars?

A biosimilar is a drug that is similar to an already-approved biologic product. Like biologics, biosimilars are made from living organisms. They have proteins that mimic certain functions in human genes or cells. Examples of biosimilars used to treat PsA include:⁹

• Amjevita™ (adalimumab-atto)
• Cyltezo® (adalimumab-adbm)
• Erelzi™ (etanercept-szzs)
• Inflectra® (infliximab-dyyb)
• Ixifi™ (infliximab-qbtx)
• Renflexis™ (infliximab-abda)
• Wezlana™ (ustekinumab-auub)

Other drugs

Several other drugs may be used to treat PsA. One option is cyclosporine, which may be used to treat severe types of psoriasis. It reduces or blocks certain immune system factors that cause inflammation in people with PsA. It is available under the brand names Sandimmune®, Neoral®, and Gengraf®.⁴

What are the possible side effects?

Side effects can vary depending on the specific type of drug you are taking.
NSAID side effects may include:²

• Upset stomach, diarrhea, and/or nausea
• Indigestion
• Headaches
• Dizziness
• Stomach ulcers, bleeding in the stomach or intestines

Corticosteroid side effects may include:³

• Fluid retention
• High blood pressure
• Irritation or allergic reaction at the injection site
• Weight gain
• Mood changes
• Insomnia
• High blood sugar

Biologic and biosimilar side effects may include:¹⁰

• Shortness of breath
• Dizziness
• Allergic reactions
• Increased risk of infections

DMARD side effects may include:⁶

• Headache
• Irritation at the injection site
• Hair loss
• Tiredness or fatigue
• Rash
• Weight loss

Cyclosporine side effects may include:¹¹

• Headache
• Nausea or vomiting
• Abdominal pain or indigestion
• Swelling, tingling, or numbness in the hands or feet
• Shakiness
• Increased hair growth
• Muscle cramps

These are not all the possible side effects of PsA drug treatments. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking 1 of these medicines.

Before beginning treatment for PsA, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.