Psoriatic arthritis (PsA) is a form of arthritis that affects some people who have psoriasis. It's a chronic, inflammatory form of arthritis that develops in the major joints.
PsA is primarily treated with injectable and oral prescription drugs. However, these drugs don't always work. They can also cause uncomfortable side effects. Because of this, a new generation of drugs called biologics is being used to treat moderate to severe PsA. Your doctor may prescribe biologics when other medications for PsA aren't working for you.
What are biologics?
Biologics are powerful, target-specific drugs. They act by blocking specific inflammatory pathways that play a role in psoriasis.
When are biologics used?
Biologics are given only when local and systemic treatments have not worked. In general, your doctor will suggest nonsteroidal anti-inflammatory drugs (NSAIDs) as the first line of medication for treating PsA. If NSAIDs don't work for you, your doctor may consider disease-modifying antirheumatic drugs (DMARDs). However, if you do not respond to DMARDs, your doctor will likely recommend biologics next.
Who is eligible for biologics?
Biologics are only prescribed to people with moderate to severe PsA. This is PsA that affects five or more joints.
There is no reliable method for figuring out how severe PsA is on its own. However, improvement in psoriasis is linked with improvement in PsA. Your doctor will likely classify how severe your PsA is based on how severe your psoriasis is. Two ways doctors measure the severity of psoriasis include the indexes below.
Psoriasis Area and Severity Index (PASI)
The PASI score is determined by the percentage of your skin affected by psoriasis. This is based on how much of your body has plaques. Plaques are patches of raised, scaly, itchy, dry, and red skin. Your doctor will determine your PASI score before and during treatment. The goal of treatment is to see a 50 to 75 percent reduction in your PASI score.
Dermatology Quality of Life Index (DQLI)
The DQLI assessment checks for the effect of psoriasis on a person's physical, psychological, and social well-being. A DQLI score of 6-10 means that your psoriasis has a moderate impact on your well-being. A score greater than 10 means the condition has a severe effect on your well-being.
Your doctor may also decide you're eligible for biologics if you have peripheral or axial psoriatic arthritis.
Peripheral psoriatic arthritis
Peripheral psoriatic arthritis causes inflammation of the joints in your arms and legs. These include:
- elbows
- wrists
- hands
- feet
Guidelines published in Rheumatology suggest that you should consider biologics if you have active peripheral psoriatic arthritis or at least three tender or swollen joints. Your doctor should also consider biologics if you've had at least two unsuccessful attempts with DMARDs. The specific biologic you're prescribed depends on your doctor. But infliximab (Remicade) or adalimumab (Humira) are the preferred choice when you also need fast control of skin psoriasis.
Axial psoriatic arthritis
Axial psoriatic arthritis causes inflammation of the joints in the following places:
- spine
- hips
- shoulders
The guidelines published in Rheumatology say that your doctor should consider biologics if you have active axial PsA.
Who is not eligible for biologics?
Not everyone is eligible for treatment with biologics. For example, you shouldn't take biologics if you're pregnant or breastfeeding. In most cases, you also should not take biologics if you have:
- a serious or active infection
- tuberculosis
- HIV or hepatitis, unless your condition is well-controlled
- cancer, now or in the past 10 years
Takeaway
Getting treatment for PsA can bring you needed relief from painful symptoms. If your current PsA treatment plan is not working as well as you'd like, ask your doctor about biologics. Biologics are strong medications that can help treat PsA. They may be an option for you if you have moderate to severe PsA, peripheral psoriatic arthritis, or axial psoriatic arthritis.
Use this article to start a discussion with your doctor. Be sure to tell them about all of your symptoms and how your PsA affects your life. Your doctor will work to find the right treatment for you.
Read more in Moderate to Severe Psoriatic Arthritis Pain Resources
