Treatment for psoriatic arthritis (PsA) may involve nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs (DMARDs), or biological therapies. Over the past few years, several new drugs have received approval for use as a treatment for this condition.
Almost one-third of people with psoriasis develop PsA. The condition most commonly develops in people ages 30–50 years. The onset may be gradual and mild, or it may be more sudden with severe symptoms.
Rheumatologists and dermatologists are typically those who treat PsA. Treatment aims to reduce pain and swelling, help the joints work correctly, and prevent ongoing joint damage.
This article looks at newly approved drugs for treating PsA, some medications still in clinical trials, and other treatments for the condition.
Over the past few years, the Food and Drug Administration (FDA) has approved several new drugs to treat PsA. The sections below look at these in more detail.
In 2017, the FDA approved the first Janus kinase (JAK) inhibitor medication, tofacitinib (Xeljanz), for treating PsA. JAK inhibitors are small-molecule medications that a person takes orally.
JAK inhibitors work by blocking the activity of JAK enzymes, which stimulate the production of inflammatory proteins called cytokines.
In 2017, the FDA approved a new tumor necrosis factor-alpha (TNF-alpha) inhibitor called golimumab to treat PsA. TNF-alpha inhibitors work by targeting TNF, a protein that causes inflammation.
A 2020 study investigated the effectiveness of golimumab as a first-, second-, and third-line biologic treatment for PsA. It was an effective treatment in all cases — particularly for first-line treatment participants, with 76.4% entering remission after 24 months.
The FDA approved the use of guselkumab (Tremfya), a new interleukin blocker, for the treatment of PsA in 2020.
It is the first treatment for PsA that specifically targets interleukin-23 (IL-23), which is a cytokine associated with inflammation in PsA. A 2021 review and meta-analysis compared the effectiveness of guselkumab with that of other interleukin blockers as well as several TNF inhibitors.
The review concludes that guselkumab’s effectiveness is comparable with the other treatments and offers a better response than many in improving skin symptoms.
A separate study suggested it was particularly effective in helping participants with inflammation of the sacroiliac joints, which include those in the spine and pelvis.
In 2017, the FDA approved the use of a new T cell inhibitor for PsA called abatacept (Orencia). T cells play a role in inflammation, and abatacept works by inhibiting T cell activation.
Researchers are currently studying several new drugs for PsA, and some in phase 3 may even become available over the next few years.
Some of these drugs include:
- Bimekizumab: This is currently in phase 3 studies. It works by simultaneously blocking interleukin-17A (IL-17A) and interleukin-17F (IL-17F), both of which are inflammatory cytokines. Bimekizumab has shown promising results as a safe and effective treatment for PsA. In phase 1 and 2 studies, 93% of participants had positive responses to the drug.
- Netakimab: This works in a similar way to current IL-17 inhibitors, such as ixekizumab. A recent phase 3 study showed that netakimab rapidly increased the participants’ quality of life, work productivity, and physical function.
- Upadacitinib (Rinvoq): Like tofacitinib, this is a new JAK inhibitor, and it is already approved for the treatment of rheumatoid arthritis. During phase 3 trials, it offered promising results. Participants had improvements in joint pain, physical function, and skin clearance.
- Deucravacitinib: This is a new tyrosine kinase 2 inhibitor, and it works in a similar way to JAK inhibitors. Participants in a phase 2 study showed symptom improvement. The drug also appears to be as safe as similar treatments. Phase 3 studies are currently ongoing.
- Brodalumab (Siliq): This drug binds to IL-17RA, which then blocks the activity of several inflammatory cytokines. Some research suggests that it may be more effective in treating moderate-to-severe cases of PsA than other biological therapies.
- Tildrakizumab (Iluyma): This drug targets IL-23 and stops the release of inflammatory cytokines, working in a similar way to guselkumab. A phase 2 study indicated that tildrakizumab significantly improved most joint- and skin-related symptoms and caused few side effects. Phase 3 studies are ongoing.
Some other potential treatments for PsA include the following:
- Light therapy: This may be a safe and inexpensive treatment option to improve skin symptoms. UVB is a type of UV light that reduces psoriasis-inducing cytokines and promotes the production of vitamin D, which is an important vitamin in treating autoimmune conditions.
- Weight management: This may play a key role in managing and treating PsA. A 2018 systematic review suggests that people with obesity had a
60% higher chanceof not responding to biologic medications than those without obesity.
- Physical therapy: This may help maintain joint function and help with weight management. Physical therapy
may be particularly beneficialfor people with comorbidities, such as obesity, cardiovascular disease, or fibromyalgia.
- Acupuncture: One
2020 case studysuggests that acupuncture may help reduce symptoms of PsA. Although more research is necessary to understand its effectiveness, it may be a low-risk and inexpensive treatment option suitable for some people.
There is no one-size-fits-all approach for treating PsA.
Current guidelines from the
They suggest that people whose conditions do not respond to their first TNF inhibitor should try another TNF inhibitor rather than using IL-17 or IL-23 inhibitors, such as guselkumab or ixekizumab.
Factors such as a person’s preference for oral medication and the location and severity of their symptoms may influence which treatment is best for them. Oral small-molecule medications, such as methotrexate, may be the best treatment option for those who experience frequent infections during treatment with TNF inhibitors or those who have a strong preference for oral treatment.
Although these are the current guidelines, the best treatment option will depend on a person’s specific situation.
A healthcare professional may try one treatment at a time or use a combination of treatments. Many medications for PsA have associated risks, so when making treatment decisions, people with PsA may wish to consider these as well as the potential benefits.
There are many different treatment options for PsA. Treatment guidelines favor biologics, such as TNF inhibitors, as a first-line treatment for most cases of PsA.
Researchers are currently studying several new treatments, suggesting a promising future for the treatment of PsA.