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Target-Specific DMARDs for Psoriatic Arthritis

Reviewed by: HU Medical Review Board | Last reviewed: February 2024 | Last updated: February 2024

One common treatment for psoriatic arthritis (PsA) is disease-modifying antirheumatic drugs (DMARDs). DMARDs reduce inflammation and can help prevent long-term joint damage, which can cause disability.1,2

There are different types of DMARDs, including traditional (or non-biologic), biologic, and target-specific DMARDs. Unlike biologic DMARDs, target-specific DMARDs are not made from living cells.1,2

Target-specific DMARDs (tsDMARDs) are intended to treat moderate to severe PsA. In some cases, these drugs are prescribed when other oral drugs have not improved PsA symptoms. Often, they are prescribed alongside other PsA treatments, such as phototherapy.1

How do target-specific DMARDs work?

The main types of tsDMARDs each target a different pathway in the immune system and act on certain proteins in the body. A pathway is a series of actions in the body that lead to a certain outcome.1

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One type of tsDMARD blocks a protein called phosphodiesterase 4 (PDE4). PDE4 plays a role in activating cells that create inflammation. It is also involved in cytokine production. Cytokines are chemical messengers that increase inflammation. Drugs that interfere with PDE4 are called PDE4 inhibitors.1,3,4

The other pathway targeted by tsDMARDs is the JAK/STAT (Janus kinase/signal transducers and activators of transcription) pathway. Some tsDMARDs block the JAK portion of the pathway. These are called JAK inhibitors. Like PDE4, the JAK/STAT pathway plays a role in releasing cytokines and activating inflammatory cells.1,2,5

By blocking these important steps in the pathway to inflammation, tsDMARDs may reduce PsA symptoms and slow joint damage.1

Examples of tsDMARDs for PsA

There are several tsDMARDs that are approved by the US Food and Drug Administration (FDA) to treat PsA. Examples of PDE4 inhibitors include:1,3,4

  • Otezla® (apremilast)

Examples of JAK inhibitors include:1,5,6

  • Xeljanz®, Xeljanz XR® (tofacitinib)
  • Rinvoq® (upadacitinib)

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. The most common side effects of target-specific DMARDs include:4-6

Upper respiratory tract infectionsRunny or stuffy noseDiarrheaNauseaHeadache

Xeljanz/Xeljanz XR and Rinvoq have a boxed warning, the strictest warning from the FDA. They have this warning because these drugs can increase the risk of life-threatening infections. These drugs may also increase the risk of cancer.5,6

These are not all the possible side effects of tsDMARDs. Talk to your doctor about what to expect when taking tsDMARDs. You also should call your doctor if you have any changes that concern you when taking tsDMARDs.

Other things to know

Because these drugs decrease inflammation and immune system response, do not start taking a tsDMARD if you have an active infection. Before starting you on treatment with a tsDMARD, your doctor may test you for tuberculosis (TB) and hepatitis B. Starting a tsDMARD when you have TB or hepatitis B can lead to severe infection.5,6

In some cases, tsDMARDs may impact your blood cell counts. They may also increase the risk of blood clots or cancer. Otezla or similar drugs may increase the risk of depression. Ask your doctor if your prescribed drug has any of these risks.4-6

Before taking tsDMARDs, tell your doctor if are pregnant, planning to get pregnant, or currently breastfeeding.4-6

Some tsDMARDs can impact a person’s ability to safely receive live vaccines. Most vaccines are not live and can still be taken. But tell you doctor if you recently received or will soon receive a vaccine.5,6

Target-specific DMARDs can interact with other drugs. Before beginning treatment for PsA, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

Treatment results and side effects can vary from person to person. This treatment information is not meant to replace professional medical advice. Talk to your doctor about what to expect before starting and while taking any treatment.