Target-Specific DMARDs for Psoriatic Arthritis

Reviewed by: HU Medical Review Board | Last reviewed: June 2022 | Last updated: December 2022

One common treatment for psoriatic arthritis (PsA) is disease-modifying anti-rheumatic drugs (DMARDs). There are different types of DMARDs. These include traditional (or non-biologic), biologic, and target-specific DMARDs. DMARDs reduce inflammation. They can also help prevent long-term joint damage, which can cause disability.

Target-specific DMARDs (tsDMARDs) are drugs that act on proteins in the body. Unlike biologic DMARDs, they are not made from living cells. They are for individuals with moderate-to-severe PsA. In some cases, they are used when other oral drugs have not improved PsA symptoms. Often, tsDMARDs can be used alongside other treatments like phototherapy.1,2

How do tsDMARDs work?

The main types of tsDMARDs target 2 pathways in the immune system. 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’s action are called PDE4 inhibitors.1-3

The other pathway targeted by tsDMARDs is the JAK/STAT pathway (Janus kinase/signal transducers and activators of transcription). Some tsDMARDs block the JAK portion of the pathway. These are called JAK inhibitors. Like PDE4, the JAK/STAT pathway plays a role in cytokine release and activating inflammatory cells.1,2,4

By blocking these important steps in the pathway to inflammation, PsA symptoms may be reduced and joint damage slowed.

Examples of tsDMARDs for PsA

There are several tsDMARDs available for PsA. Otezla® (apremilast) is an example of a PDE4 inhibitor. Xeljanz®, Xeljanz XR® (tofacitinib) and RINVOQ® (upadacitinib) are examples of JAK inhibitors.1-4

What are the possible side effects of tsDMARDs?

Side effects can vary depending on the tsDMARD you are taking. Some of the most common side effects are:3,4

  • Upper respiratory tract infections
  • Runny or stuffy nose
  • Diarrhea
  • Nausea
  • Headache

These are not all the possible side effects of tsDMARDs. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment.

Things to know about tsDMARDs

Because they decrease inflammation and immune system response, tsDMARDs can increase the risk of infection. Serious infections can be caused by fungi or bacteria and become life-threatening. Do not start taking a tsDMARD if you have an active infection. Before starting 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.

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. Your doctor can tell you if your drug has any of these risks.

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, since tsDMARDs can interact with other drugs. It is also important to take precaution if are pregnant, planning to get pregnant or currently breastfeeding.

tsDMARDs can also impact a person’s ability to safely receive live vaccines. However, most vaccines are not live and can still be taken. Talk with your doctor before starting a tsDMARD if you recently received or will soon receive a vaccine.3,4

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