Injectable Treatments for Psoriatic Arthritis: Frequency, Monitoring & Risks

Overview of Psoriatic Arthritis

A form of arthritis, psoriatic arthritis affects people who have psoriasis. Psoriasis is an autoimmune condition that is characterized by the appearance of red patches of skin that are topped with silvery scales.(1) Most people are affected by psoriasis first and then later on diagnosed to have psoriatic arthritis as well.

Stiffness in the joints, joint pain, and swelling are the major symptoms of psoriatic arthritis, and they can affect any part of your body, including the spine and fingertips. Symptoms can range from being relatively mild to severe.(2)

Both psoriatic arthritis and psoriasis are known to undergo alternate phases of disease flare-ups followed by periods of remission.

There is no cure for psoriatic arthritis as of today, but it is possible to control and manage the symptoms of the disease with medications and therapies.

In some cases of moderate to severe psoriatic arthritis, many of the conventional treatments fail to produce any positive results. In such cases, your doctor might prescribe injectable treatment for the condition that includes biologics.

Many patients with psoriatic arthritis go on to develop joint damage over a period of time. In such cases, especially using an injectable biologic can prevent further damage to the bones and joints, and also help put the disease into remission.

It is essential, though, that you understand these treatments properly before you begin them.

Different Injectable Treatment Options For Psoriatic Arthritis

In recent years, there have been a lot of new drug approvals by the US Food and Drug Administration (FDA). Due to the wide variety of injectables available, it is better that you spend some time with your doctor to discuss and understand all your options.

Injectable treatment for psoriatic arthritis means that the medication is going to be administered directly into your body. This is different from the oral route in which you take the medicine through the mouth, and it gets digested.

There are two ways in which injectables are administered into the body:

  1. Intravenous (IV) Infusion: In this method, the medication is directly delivered into a vein through a small plastic tube.
  2. Needle Injection: Needle injection is done into a muscle. It is either an intramuscular (IM) injection, or it is injected into skin tissue, a process known as subcutaneous (SQ) injection.

The most commonly prescribed injectable medication for psoriatic arthritis is methotrexate, available under the brand names of Rasuvo, Trexall, and Otrexup. Methotrexate belongs to a class of drugs known as disease-modifying anti-rheumatic drugs or DMARDs. These medications can be taken orally by mouth, which is the more common method, but they can also be administered through an injection.(3) (4)

Most doctors usually try methotrexate before moving on to the more targeted therapies known as biologic. Sometimes they may also prescribe methotrexate in combination with a biologic agent.(5)

There are many types of injectable biologic medications that are presently approved for the treatment of psoriatic arthritis. These include:

  • Ixekizumab (brand name: Taltz)
  • Secukinumab (brand name: Cosentyx)
  • Adalimumab (brand name: Humira)(6)
  • Golimumab (brand name: Simponi)
  • Certolizumab (brand name: Cimzia)
  • Etanercept (brand name: Erelzi, Enbrel)(7)
  • Infliximab (brand name: Inflectra, Renflexis, Remicade)
  • Ustekinumab (brand name: Stelara)

You should enquire from your doctor about these drugs and also review the similarities and differences between each of these biologics. If your doctor already has prescribed a particular biologic to you, then you should also find out the reason behind why the doctor has chosen that particular one first.

Frequency of Injections Treatment for Psoriatic Arthritis

Each type of these injectable biologics has a different dosage regimen. These may include administration by IV infusion, subcutaneous injections, or through intramuscular injections. Some of them are given once or twice a week, while the other is infused just once in a month.

For example, infliximab has a dosage of at least three IV infusions during the first six weeks, and then it proceeds to just one infusion in every six to eight weeks.

You should ask your doctor about the difference in dosage regimen for each biologic before making your final decision. After all, take into account your personal preferences and your time schedule while making a decision on which biologic to choose.

Furthermore, as most of these drugs are injectables, you might feel scared and overwhelmed when you first hear about undergoing an IV infusion. However, by asking your doctor everything about the procedure, including how long it will take and what it will feel like, you will feel assured going in that you are aware of what is going to happen during the infusion.

It is also possible to administer these drugs at home by yourself. As most of the biologic options come inside a pre-filled syringe, you will be ab le to inject yourself at home subcutaneously. If this will be easier for you, then you can always ask your doctor to recommend one of the medications that have to be injected subcutaneously. You will, however, need to undergo training in order to learn the proper technique for the preparation and injection of the biologic solution.

What About Monitoring?

Many of these biologic drugs that are used in the treatment of psoriatic arthritis target the body’s immune system. This often decreases your body’s ability to fight against infections, and because of this, you will need to undergo frequent testing and monitoring so as to make sure that you have not caught any infections.

Before you start taking the biologics, also you will be tested for HIV, hepatitis, tuberculosis, and some other bacterial or fungal infections. You might also be given a vaccine against tuberculosis and hepatitis B before beginning the biologic treatment so as to prevent against these infections in the time period while you are being treated with the biologic drugs.

Your doctor will also check your blood count and liver function. You should also ask your doctor about how frequently you will need to come in for getting the blood tests done after you start the biologic treatment.

Are There Any Risks of Injectable Treatments for Psoriatic Arthritis?

Just like all medications have side effects, so are there certain side effects with the injectable drugs that are used in the treatment of psoriatic arthritis. However, regardless of whether you experience the side effects or not, it is still vital that you understand the side effects of each drug and assess the pros and cons accordingly with your doctor.

Some of the most commonly reported side effects of biologic medications include:

  • Headaches
  • Stomach pain
  • Upper respiratory tract infections
  • Higher risk of catching mild to severe diseases
  • Swelling at the injection site
  • Pain and rashes at the injection site

Out of all the biologics, methotrexate is the most commonly used. Some of the commonly reported side effects of methotrexate include:(8)

Conclusion

You will start noticing some improvement in your psoriatic arthritis symptoms after the first or second injection is given. A bigger improvement will become noticeable after four to six weeks. Before you start your injectable treatment, though you must ask your doctor about what you should roughly be expecting in terms of how long it will take for you to start feeling better.

Some biologics even help achieve remission from psoriatic arthritis, and you should ask your doctor about which of these treatments will give you the greatest chance of achieving reduction.

Most doctors recommend that you continue taking biologic injections even after your symptoms disappear. It is essential to keep in mind that while the injections work well, they do not cure the underlying condition.

If after taking an injectable, you find no improvement in your symptoms or the side effects prove to be too severe for you to tolerate, then your doctor will switch you to a different biologic.

The ultimate goal of injectable medications for psoriatic arthritis is to both manage your symptoms and also prevent permanent damage to your joints. Which biologic your doctor prescribes will ultimately depending on your individual condition and the severity of your symptoms.

Biologics target your immune system, which puts you at a higher risk of developing severe infections during this time period. So take care of yourself, follow your doctor’s recommendations, and do not miss any of your injections. Otherwise, you will not be able to benefit properly from the injectable treatments.

References:  

  1. Arthritis.org. (2019). Symptoms. [online] Available at: https://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/symptoms.php [Accessed 1 Sep. 2019].
  2. Arthritis.org. (2019). What is Psoriatic Arthritis?. [online] Available at: https://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/what-is-psoriatic-arthritis.php [Accessed 1 Sep. 2019].
  3. Kingsley, G.H., Kowalczyk, A., Taylor, H., Ibrahim, F., Packham, J.C., McHugh, N.J., Mulherin, D.M., Kitas, G.D., Chakravarty, K., Tom, B.D. and O’Keeffe, A.G., 2012. A randomized placebo-controlled trial of methotrexate in psoriatic arthritis. Rheumatology, 51(8), pp.1368-1377.
  4. Kingsley, G.H., Kowalczyk, A., Taylor, H., Ibrahim, F., Packham, J.C., McHugh, N.J., Mulherin, D.M., Kitas, G.D., Chakravarty, K., Tom, B.D. and O’Keeffe, A.G., 2012. A randomized placebo-controlled trial of methotrexate in psoriatic arthritis. Rheumatology, 51(8), pp.1368-1377.
  5. Menter, A., Gottlieb, A., Feldman, S.R., Van Voorhees, A.S., Leonardi, C.L., Gordon, K.B., Lebwohl, M., Koo, J.Y., Elmets, C.A., Korman, N.J. and Beutner, K.R., 2008.
  6. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. Journal of the American Academy of Dermatology, 58(5), pp.826-850.
  7. Papoutsaki, M., Chimenti, M.S., Costanzo, A., Talamonti, M., Zangrilli, A., Giunta, A., Bianchi, L. and Chimenti, S., 2007. Adalimumab for severe psoriasis and psoriatic arthritis: an open-label study in 30 patients previously treated with other biologics. Journal of the American Academy of Dermatology, 57(2), pp.269-275.
  8. Mease, P.J., Kivitz, A.J., Burch, F.X., Siegel, E.L., Cohen, S.B., Ory, P., Salonen, D., Rubenstein, J., Sharp, J.T. and Tsuji, W., 2004. Etanercept treatment of psoriatic arthritis: safety, efficacy, and effect on disease progression. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 50(7), pp.2264-2272.
  9. Arthritis.org. (2019). Methotrexate | Psoriatic Arthritis | Arthritis Today Magazine. [online] Available at: https://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/articles/methotrexate-and-psoriatic-arthritis.php [Accessed 1 Sep. 2019].

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