Treatment for 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 as PsA treatment.

Almost one-third of people with psoriasis develop psoriatic arthritis (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.

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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.

Tofacitinib

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.

Some evidence suggests that tofacitinib is as effective as other biologic medications for people whose conditions have not responded to DMARDs. It also offers an alternative to injectable therapies.

Golimumab

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.

Upadacitinib

Upadacitinib (Rinvoq) is another JAK inhibitor that has approval for treating PsA. It may be a suitable option for treating PsA in individuals with an inadequate response or intolerance to TNF inhibitors.

A 2023 real-life multicenter study supports the effectiveness of upadacitinib for treating PsA. Similarly, another 2023 study indicates that upadacitinib is well-tolerated and has a long-term safety profile.

Guselkumab

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.

Risankizumab-rzaa

Risankizumab-rzaa is the second IL-23 inhibitor that has FDA approval for the treating active PsA in adults. The drug gained FDA approval based on the results of the KEEPsAKE-1 and KEEPsAKE-2 phase 3 studies.

These studies suggest that risankizumab-rzaa could provide significant improvement in PsA symptoms, such as reducing swollen, tender, and painful joints.

Abatacept

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.

Some research suggests that abatacept is an effective treatment for PsA but that it may be less effective for those with moderate-to-severe skin symptoms.

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 a monoclonal antibody that 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. A phase 3 trial suggests it is an effective treatment option.
  • 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.
  • Deucravacitinib: This is a new tyrosine kinase 2 inhibitor, and it works in a similar way to JAK inhibitors. A 2023 article notes that phase II clinical trials suggest that deucravacitinib is effective, well tolerated, and has a favourable safety profile. 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. A 2023 study suggests that brodalumab may be a promising option for treating PsA.
  • 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.
  • Brepocitinib: This drug is a dual inhibitor of both tyrosine kinase 2 and Janus kinase 1, which both play a role in inflammation. A phase II trial notes that it was superior to placebo and reducing PsA symptoms. The trial also suggests it is well tolerated, with a good safety profile.

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 chance of 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 beneficial for people with comorbidities, such as obesity, cardiovascular disease, or fibromyalgia.
  • Acupuncture: One 2020 case study suggests 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.
  • Stopping smoking: Guidelines for PsA treatment also advise cessation of smoking. Evidence suggests that smoking may increase the risk of devleoping PsA and can increase the severity of the disease.

There is no one-size-fits-all approach for treating PsA.

Current guidelines from the American College of Rheumatology and the National Psoriasis Foundation advise the use of TNF inhibitors, such as infliximab or adalimumab, as the first-line treatment for PsA.

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.

Some FAQs about medications for PsA may include:

What is the newest treatment for psoriatic arthritis?

Some of the most recent drugs to gain FDA approval for treating active PsA in adults include upadacitinib, risankizumab-rzaa, and intravenous secukinumab.

What is the most successful drug for psoriatic arthritis?

There is no one treatment approach for people living with PsA. As such, the effectiveness of drugs will vary from person to person. Typically, treatment plans for PsA will involve DMARDs, such as methotrexate, adalimumab, and tofacitinib.

What are the new advances in psoriatic arthritis?

A number of clinical trials are ongoing to research the effectiveness and safety of new PsA drugs. As researchers better understand potential targets for PsA treatment, they may be able to provide more personalized approaches to PsA drug treatment.

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.