Psoriatic Arthritis (cont.)
What Are Systemic Psoriatic Arthritis Medications?
Systemic medications (those taken by mouth or injection)
- Psoralens: Methoxsalen (Oxsoralen-Ultra) and trioxsalen (Trisoralen) are commonly prescribed drugs called psoralens. Psoralens make the skin more sensitive to light. These drugs have no effect unless carefully combined with ultraviolet light therapy. This therapy, called PUVA, uses a psoralen drug with ultraviolet A (UV-A) light to treat psoriasis. This treatment is used when psoriasis is severe or when it covers a large area of the skin. Psoralens are taken by mouth several hours before PUVA therapy or sunlight exposure. They are also available as creams, lotions, or in bath soaks. More than 85% of patients report relief of disease symptoms with 20-30 treatments. Therapy usually is given two to three times per week on an outpatient basis, with maintenance treatments every two to four weeks until remission. Adverse effects of PUVA therapy include nausea, itching, and burning. These drugs cause sensitivity to sunlight, risk of sunburn, skin cancer, and cataracts.
- Methotrexate (Rheumatrex): This drug is used to treat plaque psoriasis or psoriatic arthritis. It suppresses the immune system and slows the production of skin cells. Methotrexate is taken by mouth (tablet) or as an injection once per week. Women who are planning to become pregnant or who are pregnant should not take this drug. The doctor will order blood tests to check the blood cell count and kidney and liver function on a regular basis while on this medicine.
- Etanercept (Enbrel): This is the first biologic drug approved for treating psoriatic arthritis. It is a manmade protein that works with the immune system to reduce inflammation. Etanercept is given as an injection. The drug can be injected at home. Rotate the site of injection (thigh, upper arm, abdomen). Do not inject into bruised, hard, or tender skin. Enbrel affects the immune system, and individuals with significant infections are not to take this drug. It is rarely associated with heart failure.
- Adalimumab (Humira): The FDA approved this drug in 2005 for reducing symptoms of active arthritis in psoriatic arthritis. It is self-administered as an injection every two weeks. Individuals with active infections are not able to take this drug. It suppresses the immune system. It is rarely associated with heart failure.
- Infliximab (Remicade): This drug was also approved in 2005 for psoriatic arthritis. The drug must be given as a two-hour intravenous (into the vein, IV) infusion. Initially, the drug is given three times within six weeks, and then it may be administered every eight weeks. Side effects are similar to adalimumab and etanercept. It suppresses the immune system and individuals with significant infections are not to take this drug. It is rarely associated with heart failure.
- Cyclosporine (Sandimmune, Neoral): This drug suppresses the immune system and slows the production of skin cells. Cyclosporine is taken by mouth once a day. The doctor will order tests to check your kidney and liver function and levels of cyclosporine in your blood while you are on this medicine. Cyclosporine may increase the risk of infection or lymphoma, and it may cause high blood pressure.
- Ustekinumab (Stelara): This injectable biologic medication treats severe plaque psoriasis and psoriatic arthritis with or without methotrexate. There is an increased risk of infections while taking ustekinumab.
- Certolizumab pegol (Cimzia) is a TNF-blocker given subcutaneously every month. It may self-administered at home or injected in a physician's office or infusion center. It suppresses the immune system, and individuals with significant infections are not to take this drug. It is rarely associated with heart failure and other side effects.
- Apremilast (Otezla) is an oral medicine approved for the treatment of patients with moderate to severe plaque psoriasis for whom phototherapy or systemic therapy is appropriate. It is also used for the treatment of adult patients with active psoriatic arthritis. Apremilast works by inhibiting an enzyme called phosphodiesterase 4 (PDE4 inhibitor). Side effects include increase in depression and gastrointestinal upset such as diarrhea and nausea.
- As of March 2015, two new medications were on the cusp of FDA approval for patients failing the above.
- Secukinumab (Cosentyx) is a subcutaneously injected biologic medication that is targeted against a chemical messenger that is important in the inflammation of the skin in psoriasis and the joints in psoriatic arthritis. The chemical messenger that secukinumab selectively blocks is called interleukin 17 (IL-17). The most common side effects are nasopharyngeal inflammation, diarrhea, and upper respiratory tract infections.
Medically Reviewed by a Doctor on 7/14/2016
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