Psoriatic arthritis (PsA) can develop in people who have psoriasis, impacting the skin, joints, and energy levels. It’s often a painful condition and can have a significantimpacton your quality of life.
Biologic therapies have been found to behighly effectivefor psoriatic arthritis (PsA), though finding the best regimen for you can take time.Dr. Stella Bard, a board certified rheumatologist, explains how this works.
What are biologics and how do they work?
Biologics are immune treatments that are given by injection or infusion. They contain proteins thattargeta specific cytokine or protein in the blood and immune system that is involved in inflammation.
Disease-modifying antirheumatic drugs or DMARDs, in short, are used to treat psoriatic arthritis and other conditionsincluding:
BiologicDMARDs come from an animal or human source.
SyntheticDMARDs can work in a similar way but are made in a lab.
For psoriatic arthritis (PsA), biologic treatments include:
These treatments have different delivery methods, including:
Should I be worried about infection?
Some biologics are more immunosuppressive than others, depending on which cytokine they are targeting and blocking.
In general, because biologics suppress the immune system, theyincreasethe risk of common infections such as:
Antibiotics and vaccines can help reduce the risk while taking biologics for some infections, like pneumonia.
Are there any other risks?
Injection site reaction is a skin reaction at the location where the shot is injected and mightinclude:
This is not an allergy and should resolve on its own.
An infusion reaction can show as:
Patients are usually premedicated to prevent these complications and are monitored closely during their infusions.
TNF inhibitors canreactivateinfections such as tuberculosis or hepatitis B. Patients are screened for these conditions before starting treatment.
They can also cause ararelupus-like syndrome, can worsen congestive heart failure, and can cause liver problems with yellowing of the skin and eyes.
In some cases, TNF inhibitors can causeparadoxical psoriasisin people being treated for other conditions.
Biologics might slightlyincreaserisks for certain cancers and progressive multifocal leukoencephalopathy and other demyelinating disorders.
The IL-17 inhibitors such as cosentyx have ariskof inducing inflammatory bowel disease such as Crohn’s Disease or ulcerative colitis.
How do you take biologic medications?
Biologics are injected into the skin or infused into a vein. The specific dosage depends on the disease, so there are different regimens for the same drug.
For example,adalimumab (Humira) is prescribed as one injection every 2 weeks for PsA but requires a loading dose of weekly injection for psoriatic skin clearance. Humira is also used for inflammatory bowel disease.
Certolizumab pegol (Cimzia) is another TNF inhibitor that is injected as a loading dose every 2 weeks, three times in the first month, and then is followed by monthly maintenance doses.
Using the autopen
Eachmedicationwill have detailed instructions and videos on how to use. In brief, the steps are:
Using a pre-filled syringe
The steps for using apre-filled syringeare largely similar to those for an autopen. Check the exact instructions for your medication online.
Can you take biologics with other medications for PsA?
you may take biologics in combination with synthetic DMARDs such as:
Certain biologics such as IL-23 and IL-17s can beusedin combination with targeted small molecules such as Janus Kinase inhibitors while monitoring for immunosuppression. These biologics are not as immunosuppressive as TNF inhibitors and have a better safety profile.
NSAIDs and steroids can be used for symptom relief until the biologic is able to accumulate and be effective or during flares for symptom improvement.
Dr. Stella Bard is a board certified rheumatologist with over 13 years of experience in managing complex medical problems. She is a graduate of SUNY Downstate College of Medicine and completed her fellowship in UMDNJ Robert Wood Johnson. While there, she studied under world authorities in gout, Lyme disease, and scleroderma. She then set up a center dedicated to treating New York City residents living with rheumatologic conditions. As a long-time resident of the City, Dr. Bard is attuned to special health needs in its diverse communities. She serves as a medical advisor for Healthline.
