Getting Started: What to Know About Biologics for Psoriatic Arthritis

If you're struggling to get psoriatic arthritis (PsA) under control, you might consider a biologic drug. Biologics target inflammation at its source by stopping the disease processes. They provide relief from PsA symptoms, prevent joint damage, and improve quality of life.

This article delves into whether biologics make sense for you, how they work, and how to get started.

Biologics for Psoriatic Arthritis

Verywell / Zoe Hansen

Basics of Psoriatic Arthritis

PsA is a type of inflammatory arthritis that often affects people who already have the inflammatory skin condition psoriasis.

Psoriasis is known for causing patches of red, inflamed skin with white, silvery flakes. PsA affects up to 30% of people with psoriasis.

Joint pain, stiffness, and swelling are the main symptoms of PsA. These symptoms can affect any part of the body, including the fingers and spine, and symptoms range from mild to severe.

PsA, much like psoriasis, causes periods of flare-ups (high disease activity) and periods of remission (reduced or no symptoms). 

There's no cure for PsA. Healthcare providers focus on controlling symptoms and preventing joint damage. Without treatment, PsA can lead to permanent damage and disability.

Biologics are a type of disease-modifying anti-rheumatic drug (DMARD) designed to manage PsA symptoms and slow down PsA disease progression.

Researchers consider biologic drugs to be the most targeted therapies for treating PsA.

Traditional DMARDs, like methotrexate, suppress the entire immune system. Biologics only target parts of the immune system that are linked to PsA. This includes immune cells and inflammatory proteins such as:

These cells and proteins play a significant part in the development and progression of PsA and psoriasis.

Types of Biologics for PsA

Many biologic drugs can treat PsA. Each type of biologic targets a different pathway thought to promote the disease. 

Your healthcare provider will look at your overall health, lifestyle, and severity of your disease to decide which biologic might be best for you.

Biologic Drugs for Psoriatic Arthritis
 Trade Name  Generic Name Target
Cimzia certolizumab pegol  TNFα
Enbrel etanercept TNFα
Humira adalimumab TNFα
Remicade infliximab TNFα
Simponi golimumab TNFα
Simponi Aria golimumab TNFα
Stelara ustekinumab IL-12/23
Cosentyx secukinumab IL-17
Siliq brodalumab IL-17
Taltz ixekizumab IL-17
Orencia abatacept T-cells
Ilumya tildrakizumab-asmn IL-23
Skyrizi risankizumab-rzaa IL-23
Tremfya guselkumab IL-23
Source: National Psoriasis Foundation

The types of biologics available for treating PsA include:

  • TNF inhibitors: Bloc TNFα, a protein that signals the body to create inflammation. People with PsA have excess TNFα in their joints and skin. Ongoing inflammation can lead to rapid skin cell growth and joint tissue damage.
  • IL-12/23, IL-17, and IL-23 inhibitors: Target these specific cytokines that are connected to psoriatic inflammation. Leads to less pain, fewer symptoms, and a halt in disease progression.
  • T-cell inhibitors: Block the inflammatory activity of T-cells, which are white blood cells involved in PsA.

Your healthcare provider is in the best position to tell you whether you might benefit from biologic treatment. In general, these drugs are prescribed to people with moderate to severe PsA. 

They're also prescribed when other treatments haven't worked, or when you cannot take other treatments because of side effects or for some other reason.

What To Expect

Biologics are administered either through injection or using an IV infusion (intravenously using a needle directly into the arm).

Most biologic injections are done at home by yourself or with the help of a loved one. Infusion therapy is done at your healthcare provider’s office, a hospital, or an infusion center.

Injections

Many of the biologic drugs approved for treating psoriatic arthritis are injected subcutaneously (under the skin). Subcutaneous injections are given in areas where you can pinch the skin, i.e., the abdomen or thighs.

Injections you can give yourself at home either come as a single-use syringe or a pen-like auto-injector. There are also powdered formulas in single-use vials. But because these require exact amounts of sterile water, they are often only used in medical settings.

Each biologic comes with preparation and dosing instructions. Your provider can give you this information and walk you through the steps for injecting yourself. The drug packaging also provides step-by-step instructions.

Dosages for biologic injections will be different based on the drug you're taking. Some are given once or twice a week, some are once every other week, and others are once a month.

If you have questions about your dosage schedule, talk to your provider or pharmacist. 

Infusions

Biologic infusions used to treat PsA include Remicade and Simponi. These medications are given through an IV drip into a vein.

An infusion appointment can take two or more hours to complete. Typically, infusion treatments are done every few weeks.

When you arrive to get your infusion, the clinician will place an IV into your vein, connected to a thin tube. Once the IV is placed, the clinician will start the infusion, and the medicine will move through the thin tube into your vein.

Make sure you feel well when you show up for an infusion appointment. This is to protect yourself and others who might also be immunocompromised (having a weak immune system). 

Most biologic treatments weaken your immune system. If you have an infection that is starting, having an infusion can make it worse.

After your first infusion, you will be monitored for up to an hour for any signs of an allergic reaction—swollen lips, shortness of breath, rash, etc. You'll get information about what side effects to watch out for and who to contact about them.

Headaches are common after biologic infusions and are often caused by fluid changes in the body. Fortunately, these headaches are temporary and should resolve within a day. 

The effects of a PsA biologic begin a few weeks after the initial treatment. After you have had a few infusions, you will start to see the full effects, which can last for several months.

Talk to your healthcare provider about how you can best manage symptoms until your infusion treatments take effect.

Biologics Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Woman talks to her doctor

Risks and Side Effects 

All treatments come with risks and benefits, and these should be weighed carefully before starting a new treatment.

Your healthcare provider is in the best position to explain all the pros and cons of biologic therapy for PsA and which drug might be best for your unique situation.

The most common side effects of biologics used for PsA include:

  • Respiratory infection
  • Injection site reactions
  • Flu-like symptoms

These side effects are generally mild. More serious side effects are rare. They include:

Getting Started 

It's typical to try traditional DMARDs like methotrexate before starting on a biologic. Biologics are expensive drugs. Some insurance companies won't cover them unless traditional therapies have failed.

To see whether your'e a candidate for biologics, your healthcare provider will do a full assessment of your health, including your medical history, a physical exam, bloodwork, and other tests.

Let them know about other medications you are taking and take any vitamins and supplements. Some medications and supplements may interact with biologics.

You should hold off on starting a biologic when you are sick, even if it is as simple as the common cold. This is because biologic therapy impairs the immune system and increases infection risk.

Some mandatory steps must be taken before you start on a biologic:

  • You'll be tested for tuberculosis (TB) and hepatitis due to the increased risk of infection and reactivation.
  • You'll need to be brought up-to-date on vaccinations.

Once you start a biologic, you are not only at greater risk for infection, but ineligible to receive live vaccines such as varicella and MMR (measles, mumps, and rubella) due to health risks. Getting your vaccines before starting the medication allows you to get protection from certain diseases before you are no longer able to.

Once you start biologic therapy, check with your healthcare provider before getting any routine vaccines.

Talk to your provider about your risk for certain types of cancer. Some research has linked biologic drugs with an increased risk for skin cancers and lymphoma. This risk shouldn’t stop you from starting biologics, but you may need to be monitored while taking them.

Health Disparities

Access to biologic treatment for psoriatic arthritis can be impacted by your race or ethnicity.

According to a 2015 study involving urban health institutions, Black people with PsA are far less likely to be prescribed biologics than White people. In fact, 46.2% of White people got biologics, compared to 13.3% of Black people.

Researchers said that lack of access to biologic drugs led to more severe disease, greater psychological impact, and lower quality of life.

A 2013 study showed South Asian Americans with PsA are also less likely to be treated with biologics than those with European ancestry. This study also found disparities in the treatment of Black people.

Additional Considerations

Your experience on biologic drug therapy for PsA will be different than someone else’s. There will be several things to consider as you start biologic therapy and as you continue the course.

Improvement Takes Time

It may take three or more months of biologic treatment to feel less pain and have symptom improvement from PsA. However, studies have found biologics can offer mood improvements in a shorter time.

This is important because people with PsA have a higher risk for depression and a depressed mood can worsen pain perception. That means the sooner you feel better mentally and emotionally, the sooner you'll feel better physically. 

Drug Costs 

Biologics are expensive. They can cost anywhere from $10,000 to $30,000 a year.

If you have insurance, your provider will work with your carrier to find a biologic that's covered.

If you're not insured or your insurances leaves you with a large share of the cost, look into drug manufacturers' patient assistance programs. They can reduce costs so you can have access to the drug your healthcare provider chooses.

Managing Flares

Even on biologics, you might still experience flare-ups—periods where symptoms are worse than usual. Flare-ups are unpredictable—you might feel fine one day and the next, you are struggling to get out of bed.

If you are experiencing frequent flare-ups or short breaks between flares, you might want to talk to your healthcare provider about whether your biologic is helping or whether it is time to start a different biologic for treating PsA.

Your biologic may not always be the reason you are experiencing flare-ups. PsA is associated with triggers—disease and lifestyle patterns that trigger symptoms. This might include things like cold weather, stress, diet, smoking, and overconsumption of alcohol.

Doing what you can to avoid triggers can pay off in the form of less pain, fewer symptoms, and improved quality of life.

Prioritizing Mental Health

Prioritizing your mental health can also help. Research shows people with PsA have a higher risk for depression and anxiety. And people who struggle to cope are more likely to experience PsA flare-ups.

Do what you can to invest in your mental health and better learn to cope with the many aspects of living with PsA, including joint and skin pain and fatigue.

You should also make sure you are making healthy lifestyle choices, including:

  • Eating healthy
  • Staying active
  • Not smoking
  • Not overindulging in alcohol

Sticking To Your Treatment Plan

Treating PsA takes a lot of work, and it can be hard to keep up with all the aspects of your care. The Psoriasis Foundation says the main reason PsA treatments fail is that people don't stick to them properly.

Biologic therapy comes with some challenges, including high costs, fear of side effects, not feeling better quickly enough, or the timing of treatment might be inconvenient. It is also not uncommon for people to feel wary of biologics.

But your healthcare provider has prescribed biologic drug therapy because they have determined the benefits outweigh the risks. And, fortunately, most of the newer biologics are effective and safe to use.

Stopping treatment, regardless of the reason, is never a good idea. You will likely find yourself with increased PsA symptoms and flares as soon as you stop using your biologic or other treatments. The decision to stop or reduce treatment should be made between you and your provider.

Summary

Biologic drugs for psoriatic arthritis target various components of the inflammation response. The goal is to stop inflammation, relieve symptoms, and prevent further damage. They are usually considered after first trying other treatments.

Biologics are given by infusion or injection. Side effects include impaired defense against infections.

A Word From Verywell

Most people who try biologic drugs to treat psoriatic arthritis will see improvement in their symptoms. Follow your healthcare providers' instructions for these treatments carefully.

It is also important to go to all regular follow-up medical visits to make sure your biologic is still working. When you see your medical provider, be sure to tell them about any problems or side effects you are experiencing. 

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