Psoriatic arthritis (PsA) is a chronic, inflammatory form of arthritis. Various treatments are available for treating symptoms and slowing disease progression, many of which are available orally.

Doctors may prescribe various medications to treat PsA. In this article, Dr. Stella Bard applies her expertise in rheumatology to answer questions about the various oral PsA treatment options available.

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Various oral treatments are available for PsA, including:

What is the new oral medication for psoriatic arthritis?

Upadacitinib received Food and Drug Administration (FDA) approval to treat PsA in 2019.

A drug that shows promise in treating PsA is deucravacitinib, which the FDA has already approved to treat plaque psoriasis. Deucravacitinib is currently under evaluation in phase 3 clinical trials but does not yet have FDA approval.

In a phase 2 clinical trial, deucravacitinib was effective in treating some aspects of PsA, had a good safety profile, and was well tolerated by people with the condition.

NSAIDs are anti-inflammatory medications that people can take for mild PsA to treat joint pain, stiffness, and swelling. They work quickly by blocking the enzymes cyclo-oxygenase 1 and 2. This leads to decreased production of prostaglandins, which are hormone-like substances that bring on joint and spine pain and inflammation. However, they do not slow disease progression.

Otezla blocks the making of the enzyme phosphodiesterase 4. This helps decrease inflammation in the body, which can help improve PsA symptoms.

Conventional DMARDs work broadly throughout the body to slow disease progression and prevent irreversible, permanent joint damage that can otherwise occur with long-term joint inflammation.

To prevent inflammation, targeted synthetic DMARDs inhibit the JAK family of proteins, including JAK 1, 2, and 3 and tyrosine kinase 2. Cytokines are proteins in the body that signal cells to produce inflammation. JAK inhibitors interfere with this signaling process. Different JAK inhibitors block different inflammatory proteins.

Usually, the type of PsA someone has would determine the medications a doctor prescribes.

Doctors typically prescribe oral medications when PsA affects the hands and feet. If the condition affects the spine, they typically prescribe a biologic medication rather than an oral medication.

In moderate to severe disease, if prescription NSAIDs are insufficient to treat PsA, experts typically recommend conventional DMARDs.

If DMARDs are ineffective, or if a person does not tolerate them well, a doctor can add a JAK inhibitor, or the individual can take it alone as monotherapy. Another option is Otezla, which a doctor can prescribe on its own or with a conventional DMARD.

Yes, in fact, doctors often combine them to increase each other’s effects.

Doctors can combine up to three conventional DMARDs with one another. A person can also take Otezla with a conventional DMARD. Doctors can also combine targeted synthetic DMARDs with conventional DMARDs.

A person can work with their doctor to determine the best medication, or combination of medications, to treat their psoriatic arthritis.

Conventional DMARDs, targeted synthetic DMARDs, and Otezla can slow the inflammatory process and decrease the chances of permanent, irreversible joint damage, which can otherwise occur after inflammation over time.

NSAIDs can irritate the gastrointestinal tract, which may cause an ulcer or gastrointestinal bleeding. These drugs can also lead to heart problems, kidney damage, and in rare cases, liver damage.

Otezla may also irritate the gastrointestinal tract and lead to issues, such as abdominal pain, diarrhea, nausea, and vomiting. It may also cause headaches and symptoms such as cough, runny nose, or fever.

Side effects of conventional methotrexate and sulfasalazine include bone marrow suppression, which refers to a reduction in blood cell production. Methotrexate can cause liver damage and lung inflammation, leading to scarring or fibrosis.

Methotrexate is also an abortifacient, which is a drug that causes abortion, and pregnant people or those who plan to become pregnant must avoid it due to its harmful effects on a fetus. Those taking methotrexate need to avoid drinking alcohol since both can damage the liver.

Sulfasalazine can also reversibly lower the sperm count in men. It can also cause gastrointestinal symptoms such as nausea, vomiting, heartburn, headache, and rash.

Leflunomide can harm a fetus, and it can remain in the body for 2 years. Should a person become pregnant while taking it, it requires a washout of the body within 2 years of taking it. It can also cause life threatening liver damage. People must avoid taking this medication if they have liver disease, consume alcohol heavily, have hepatitis, or take other medications that can cause liver damage.

Hydroxychloroquine can cause gastrointestinal side effects such as loss of appetite, nausea, vomiting, or abdominal pain. More importantly, it can worsen psoriasis, so while doctors can prescribe it to those with PsA, those people must avoid taking it if they also have psoriasis.

All JAK inhibitors have a cancer warning. Xeljanz may also increase the risk of blood clots in the lungs and major blood vessels, especially in those at risk. Therefore, people with risk factors for heart disease or who have had a blood clot in the past should not take the medication.

A person should expect to start noticing some relief in 3–6 weeks. The complete effect of the treatment should be noticeable in 3 months.

If a person is unhappy with the results of their treatment regimen, they can talk with their doctor.

If a person misses a dose of their PsA treatment, they need to take it as soon as they can. However, if it is already time for the next dose, they should not take a double dose to make up for the missed dose. A person needs to talk with their doctor if they regularly miss doses of their medication.

Yes, methotrexate, Otezla, and JAK inhibitors also help improve psoriasis skin involvement. However, hydroxychloroquine can worsen psoriasis.

PsA is a chronic or lifelong disease requiring ongoing treatment. However, with the right treatment plan in place, remission is possible. If a person experiences remission, they can work with their doctor to adjust their treatment plan.

Dr. Stella Bard is an ABMS board certified rheumatologist with more than 10 years of hands-on experience in managing complex rheumatologic concerns. She is currently a practicing physician in the states of New York and Texas.