Psoriatic arthritis (PsA) can cause swollen and tender joints. It often affects people with psoriasis, an immune-mediated condition that causes skin-related symptoms. The drug apremilast may help treat PsA symptoms by reducing inflammation, but it can cause side effects that could affect physical performance.
PsA is a form of arthritis that can occur in people with psoriasis. People with PsA and psoriasis may experience joint pain, swelling, and scaly patches or plaques on the skin.
Apremilast is a medication that works to stop certain substances in the body from causing inflammation. Although it may be effective in reducing the symptoms of PsA, its side effects might affect athletic performance.
This article looks at whether apremilast is safe for athletes. It considers the drug’s possible side effects and its effectiveness in treating PsA.
A healthcare professional may prescribe apremilast to treat or manage the following conditions:
- PsA
- plaque psoriasis
- mouth ulcers from Behçet’s disease
Apremilast is a disease-modifying antirheumatic drug (DMARD) that stops the body from producing a particular enzyme called phosphodiesterase 4 (PDE4). Blocking PDE4 production reduces inflammation.
The Food and Drug Administration (FDA) approved apremilast as the first oral drug for treating PsA.
People take apremilast orally in tablet form, usually twice a day at the same times.
People need to swallow the tablets whole rather than crushing, chewing, or splitting them. Apremilast is suitable to take with or without food.
People may begin with a dose of 10 milligrams (mg), which they will increase up to a maximum of 30 mg over the course of 5 days. This approach helps minimize potential side effects when first taking the medication.
People may need to take apremilast for up to 4 months before they notice a reduction in their symptoms. It is important to take apremilast as the doctor prescribed it.
People may remain on the medication in the long term if they tolerate it well and it is effective in treating their symptoms.
There is no research suggesting that apremilast is unsafe for athletes. However, certain side effects may affect athletic performance.
The most common side effects of apremilast are nausea, diarrhea, and headaches.
Gastrointestinal symptoms usually appear within the first 2 weeks of starting apremilast and resolve within 4 weeks, even with continued use of the drug.
In some people, apremilast may cause weight loss. According to the American College of Rheumatology, clinical trials have found that 10% of people taking apremilast lose 5–10% of their body weight, compared with 3.3% in those taking a placebo.
A 2019 study compared the use of apremilast and a placebo in 1,493 people with PsA. Among those taking apremilast, most people kept their weight within a 5% range of their starting weight.
Athletes may need to talk with their sports and healthcare teams to discuss how they may manage any potential weight loss. It may be necessary to stop taking apremilast if it causes significant weight loss.
Apremilast may also have a psychological impact on some people, which may affect physical performance.
For instance, in one clinical trial, 1% of people taking apremilast reported depression or depressed mood compared with 0.8% of people taking a placebo. Suicidal thoughts and behaviors affected 0.2% of people taking apremilast but none of those in the placebo group.
Further research involving more people is necessary to confirm these findings, but anyone with a history of mental health issues should discuss this with a healthcare professional before taking apremilast.
Common side effects of apremilast include:
- nausea
- vomiting
- diarrhea
- headaches
- cold-like symptoms, such as a cough or runny nose
- respiratory tract infections
These side effects usually occur within the first few weeks of beginning apremilast and often resolve without treatment while a person continues taking the drug.
Although they do not generally last in the long term, they could affect an athlete’s training and competition performance in the short term.
Apremilast poses some risks, including unintended weight loss and effects on mental health.
People with chronic kidney disease may need a lower dosage of 30 mg apremilast once a day.
Researchers have not studied apremilast in pregnancy. Apremilast may only be suitable if the likely benefits of taking the drug outweigh any potential risks to the developing baby.
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People will need to inform a healthcare professional of any medications, supplements, or herbal remedies they take in case they interact with apremilast. Interactions may occur with various treatments, including:
- carbamazepine (Tegretol)
- phenobarbital (Luminal)
- phenytoin (Dilantin)
- rifampin (Rimactane)
- St. John’s wort
Apremilast may not be suitable for people who:
- have not already tried other treatments
- have depression or a history of mental health issues
- are pregnant or are planning to become pregnant
- have lactose intolerance
- are underweight
- have impaired kidney or liver function
Apremilast may be suitable for people with moderate joint and skin symptoms as an alternative to biologic DMARDs.
It may be effective in reducing swollen and tender joints in people with PsA. In those also living with psoriasis, it might relieve skin symptoms, including psoriasis on the scalp and nails.
People may start to experience improvements within 4 months of beginning treatment.
Researchers have found apremilast to be safe and beneficial in people taking the drug for up to 5 years to treat PsA.
Apremilast is an FDA-approved drug for the treatment of PsA. It works by blocking a specific enzyme that causes inflammation in the body, helping relieve joint pain, swelling and tenderness, and skin symptoms.
Apremilast can produce side effects, including nausea and diarrhea, although these usually resolve with continued use of the drug. In some cases, apremilast may lead or contribute to depression or weight loss.
There is no evidence to suggest that apremilast is unsuitable for athletes to take. However, if a person has concerns about how the drug’s possible side effects may affect their physical performance, they can discuss the potential risks and benefits with a healthcare professional.