3 Reasons You May Need to Change Your Psoriatic Arthritis Treatment

When you need drugs for psoriatic arthritis, it can take some trial and error until you find the medication that’s best for you.

woman taking medication
If your psoriatic arthritis medication isn’t working, your doctor may up the dose, try a different drug of the same type, or switch to an entirely different drug class.Getty Images

When you’re newly diagnosed with psoriatic arthritis?(PsA) and prescribed medication, know there’s a good chance your treatment plan may need to change before too long.

The first few months after a psoriatic arthritis diagnosis can be tricky, as you and your doctor figure out which medications are most effective for you. It’s often a process of trial and error that may involve starting a new medication or adding one to your treatment regimen.

“The start of psoriatic arthritis treatment is the most trying time,” says Elyse Rubenstein, MD, a rheumatologist at Providence Saint John’s Health Center in Santa Monica, California. “You’re trying to find out what will put you in remission. But even after you’re in remission, there’s a chance the disease could flare, and you could need to switch medications again.”

There is no set treatment for this condition — a medication that works well for one person might not be effective for someone else. Even the drug for psoriatic arthritis that works for you now might not be as successful in a few months.

One study has shown that among the different biologic drugs for psoriatic arthritis and targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs), “there is substantial variability in persistence, discontinuation, adherence, reinitiating, and switching patterns.” While 31 to 59 percent of patients stayed with their initial drug, 35 to 56 percent discontinued that therapy; 28 to 57 percent switched to a different biologic or tsDMARD.

Common Questions & Answers

Is psoriatic arthritis curable?
There’s no cure for psoriatic arthritis, but there are plenty of therapies to help lessen the discomfort and joint damage.
What are the symptoms of psoriatic arthritis?
Not everyone with the disease experiences the same problems. Symptoms may include stiff, painful joints; redness, heat, or swelling in the tissues surrounding the joints; and hand deformities.
What causes psoriatic arthritis?
Doctors aren’t exactly sure what causes psoriatic arthritis, but they do know it happens when your body’s immune system starts to attack healthy tissue. This causes an overproduction of skin cells and inflammation in your joints.
Are there different types of psoriatic arthritis?
There are five different types of psoriatic arthritis, including symmetric psoriatic arthritis, asymmetric psoriatic arthritis, spondylitis, arthritis mutilans, and distal psoriatic arthritis.
How is psoriatic arthritis diagnosed?
To diagnose psoriatic arthritis, your doctor will probably first perform a physical exam to look for swollen joints. You may undergo an X-ray, magnetic resonance imaging (MRI), ultrasound, or computerized tomography (CT) scan. You might also need to have a blood test to rule out other related conditions, such as rheumatoid arthritis.

Which Psoriatic Arthritis Medication Is Right for You?

When you first receive your?psoriatic arthritis diagnosis, your doctor will take several things into account when deciding which drug to recommend. A major consideration is the severity of your symptoms, Dr. Rubenstein says.

PsA drugs include:

Over-the-counter NSAIDS,?like?ibuprofen (Advil, Motrin), or prescription NSAIDs such as meloxicam (Mobic) may be enough to treat mild PsA symptoms. In cases where they’re not, another option could be a nonbiologic DMARD like methotrexate. For more severe symptoms, a biologic drug could be the answer.

If you have other health conditions, your doctor will also take those into consideration. For example, people with high blood pressure need to be monitored for increased?hypertension?if they take?NSAIDs,?according to the Cleveland Clinic.

?Individuals with congestive heart failure?or those who have a family history of demyelinating diseases, such as multiple sclerosis and Guillain-Barre syndrome, may want to avoid certain biologic medications, Rubenstein says.

Other considerations include any medication allergies you may have and your level of comfort with nonoral drugs. Many drugs for psoriatic arthritis are given via injection or intravenously.

When Your Psoriatic Arthritis Treatment Plan May Be Adjusted

There may be several reasons why your doctor may recommend changing your medication regimen, including the following:

1. You haven’t reached your treatment goals.

One way to measure whether your psoriatic arthritis medication is doing what it should is a strategy called treat-to-target (T2T), according to the Arthritis Foundation.

?In T2T, the doctor sets a predetermined treatment goal, which is usually remission or very low disease activity, and then evaluates the patient periodically (usually every three to six months) to see if they’ve reached the goal. If they haven’t, the physician may increase the medication dose, try a different drug of the same type, or switch to a different drug class altogether.
In treating psoriatic arthritis, it’s important to note that two drugs may not be better than one. Results of a study published in The Lancet: Rheumatology, found that on average, using methotrexate for psoriatic arthritis in addition to ustekinumab (Stelara) or a tumor necrosis factor inhibitor (TNFi) didn’t improve the ability of patients to reach their composite treatment targets.

It’s also worth noting that T2T can be tricky when it comes to psoriatic arthritis, because PsA affects the body in a number of different ways and improvement in one area might not correlate to improvement in another, notes the Arthritis Foundation.

2. You’re experiencing side effects.

Some psoriatic arthritis medications may cause side effects that are bothersome enough to require discontinuing the drug. Side effects may include gastrointestinal irritability, nausea, headaches, and rashes, Rubenstein says. People who take a medication that suppresses the immune system may develop an infection, making it necessary to stop the drug.

Research shows that side effects often affect drug retention rates, causing PsA patients to stop taking their medications.

However, medications should never be stopped without first consulting your doctor, who can determine the cause of any side effects and adjust your treatment plan accordingly.

3. You’re not taking the drug properly.

It can be difficult to follow a medication schedule, says Ellen Amanda Snyder, MD, assistant professor of medicine in the division of rheumatology, allergy, and immunology at the UNC School of Medicine in Chapel Hill, North Carolina. Remembering what you need to take and when you need to take it while also managing work, family, friends, and other commitments isn’t easy, though it does make a real difference, she says. “I find that patients do best when they are able to really focus on taking their medications as prescribed,” says Dr. Snyder.

If that’s something you struggle with, talk with your doctor. They may be able to suggest ways to help you adhere to your medication schedule or switch you to a treatment that’s easier for you to manage.

RELATED: 6 Reasons Why People Quit Their Psoriatic Arthritis Meds — And Why You Shouldn’t

Psoriatic Arthritis Treatment: A Long-Term Process

When you’re trying to figure out which psoriatic arthritis medications work best for you, patience is key, Rubenstein says. “How long you need to wait depends on the medication,” she says. “If you’re trying a biologic drug, you should give it about three months. For methotrexate in particular, give it three months at a minimum to start to work.”

Talk to your doctor about the risks and benefits of your treatment. One study found that some people with mild psoriatic arthritis symptoms were willing to risk relapse rather than suffer from medication side effects such as severe nausea.

People with psoriatic arthritis should also remember that the goal of treatment is low disease activity — meaning pain relief and the ability to perform tasks like walking, working, and exercising with little or no trouble. If a medication alleviates only some of your pain, it’s not working properly.

“You want to be functional,” Rubenstein says. “Some people might have five minutes of morning stiffness but then they’re fine, and that’s okay. But if you’re having three hours of morning stiffness every day, something’s wrong.”

Additional reporting by Becky Upham.

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  1. Murage, MJ et al. Treatment Patterns and Health Care Costs Among Patients With Psoriatic Arthritis Treated With Biologic or Targeted Synthetic Disease-Modifying Antirheumatic Drugs. Journal of Managed Care & Specialty Pharmacy. February 2022.
  2. NSAIDs. Cleveland Clinic. July 24, 2023.
  3. Using Treat-to-Target for PsA. Arthritis Foundation.
  4. Koehm, M et al. Methotrexate Plus Ustekinumab Versus Ustekinumab Monotherapy in Patients With Active Psoriatic Arthritis (MUST): A Randomised, Multicentre, Placebo-Controlled, Phase 3b, Non-Inferiority Trial. The Lancet: Rheumatology. January 2023.
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