Psoriatic Arthritis Treatment: Signs You Should Switch

Psoriatic arthritis (PsA) is a type of inflammatory arthritis. It affects the joints, tendons, and the entheses (the areas where tendons and ligaments meet bone) throughout the body. It occurs in about one-third of the people with the autoimmune skin condition psoriasis. PsA may also affect the spine, leading to back and hip pain.  

Treatments for PsA can help reduce symptoms, joint and tendon damage, and the potential for disability. But even with treatment, it is possible to still have joint pain, stiffness, and swelling.

Having symptoms despite doing everything necessary to manage PsA is a sign your treatment plan might not be working. That is because treating PsA is not a one-size-fits-all solution. What works for someone else may not work for you.  And there might be other reasons to consider a switch, such as your ability to keep up with treatments or if you get pregnant.

Fortunately, you have many options for treating PsA, including systemic corticosteroids, disease-modifying antirheumatic drugs (DMARDs), biologics, and Janus kinase (JAK) inhibitors. 

This article will cover signs that your treatment plan isn’t working, how to switch treatments, available treatments, and more.

Signs Your Current Psoriatic Arthritis Treatment Isn’t Working

Ongoing treatment for PsA is necessary to prevent joint damage and other complications like heart disease and life-threatening infections. But finding the right medicine or combination of medications for PsA can be hard, and there are times when you may find you need to make changes to your treatment plan.  

Here are some signs that it might be time to speak to your healthcare provider about changing your current treatment plan.  

You’re Experiencing Serious Side Effects  

All medications cause side effects. They are common when you first start taking a new drug, when you stop a drug you have been taking for a long time, and when doses of medications are increased or decreased. For most people, the side effects of a new medication subside once they have been using the treatment for a few weeks.

Side effects of a medication your healthcare provider has prescribed might be bothersome enough for you to quit the treatment. According to a 2014 study, more than 40% of people who stopped using their biologic treatments did so because of side effects.

If you experience harsh side effects from a PsA treatment, reach out to your healthcare provider. Do not stop taking a prescribed medicine without first talking to your healthcare provider. They can best determine the cause of side effects and make needed adjustments to your treatment plan.

You Aren’t Seeing Results

First, be aware that DMARDs and biologics can take up to three to six months to become effective. If that time has passed and you are taking your medications exactly as prescribed and are not seeing improvements, it might be time to try something new. This is especially important if PsA starts to affect your daily functioning.

Some people can develop anti-drug antibodies against some biologic medications, leading them to become ineffective. DMARDs and other PsA medicines may also become less effective for a person over time. Switching out medicines can be beneficial in these instances.

Healthcare providers will measure how well your PsA treatment works using a treat-to-target (T2T) strategy. With T2T, your healthcare provider will set a treatment goal—usually remission or low disease activity.

They will then test you every three to six months to see if you have reached the goal. If you have not, your healthcare provider may increase your medication dosage, try a different drug from the same class, or switch to a drug in another class.

You’re Experiencing New Symptoms  

If you experience new symptoms, more severe symptoms, and an increase in flare-ups (periods of increased symptoms), your treatment plan likely isn’t working.  

Talk to your healthcare provider about any of these new symptoms or these symptoms worsen: 

• Pain, swelling, and stiffness in joints previously not affected by PsA
• Nail symptoms
• Back or hip pain
• Frequent bowel troubles, such as bloody stools and diarrhea, which might mean bowel inflammation
• Swollen fingers and toes
• Eye inflammation, including redness, pain, and blurred vision
• Severe fatigue 

Joint and bone damage or changes might also be a reason to amend your treatment plan. If, for instance, X-rays or other imaging shows bone and joint damage or active, ongoing inflammation, you and your healthcare provider might discuss switching to a new DMARD, biologic, or a JAK inhibitor drug.

Your Current Treatment Is Too Expensive

Many of the medications you take to treat PsA can be expensive. According to a 2018 report in the journal Drugs, a biologic drug can cost anywhere from $10,000 to $30,000 per year and can exceed $500,000 for the most expensive biologics. Even with good health insurance coverage, you can still have high out-of-pocket costs.

If you cannot afford your medications, you might have other options, including:  

• Talk to your healthcare provider: Your healthcare provider can prescribe a less costly medication, or they can offer information on how to cut your medication costs.
• Look for financial assistance: Many drug manufacturers and nonprofit organizations can offer free or discounted medications if you qualify. Check the National Psoriasis Foundation’s website for information and resources.
• Compare drug prices: Medication costs can vary by pharmacy. GoodRx can be a helpful resource for comparing drug costs. They can also help you find medication coupons to bring down medication costs at the pharmacy.

You Can’t Keep Up With Your Dosage

Some medications might be taken orally daily, whereas others, like biologics, might be taken once per week and every week. Other PsA drugs are given by intravenous (IV) infusion, which requires you to go to an infusion center or medical facility to get treatments, which can take up a few hours of your day.

When you choose a treatment, be mindful of your schedule, lifestyle, and other preferences that will allow you to keep up with the treatment. 

It is also possible that aspects of your life may change, making it harder to follow your treatment plan.

For example, if you change jobs and have a different work schedule, you may be unable to miss work for infusions. You will want to ask your healthcare provider about alternatives, such as a biologic injection. Or you may simply prefer treatments that require less frequent dosing.  

Whatever your reasons are, your healthcare provider will want to work with you to keep you on track. Talk to your healthcare provider if you struggle to take your medications properly or keep up with doses. They can suggest better ways to stay on top of your treatments or switch you to a treatment plan that is easier to manage.

You’re Pregnant or Want to Become Pregnant  

The effects of systemic drugs (including DMARDs and biologics) on an unborn fetus are not fully understood. The guidance from the National Psoriasis Foundation is that some of these drugs should be avoided in pregnancy because they might be linked to miscarriage or congenital disabilities.

If you are pregnant or thinking about getting pregnant, you might need to stop or switch treatment. Don’t stop any treatment until you have spoken with your healthcare provider.

Your healthcare provider can suggest safer alternatives to take during pregnancy, including biologics like Cimzia (certolizumab). Research on Cimzia shows it to be one of the safest biologics available and that it’s safe for use during pregnancy as it doesn’t cross the placenta, unlike other biologics.

You’re Excessively Tired  

Psoriatic arthritis causes fatigue, which can be severe at times. The medications you take to treat PsA can reduce fatigue, pain, and other PsA symptoms. Even so, you can still experience fatigue that keeps you from carrying out day-to-day activities.

Fatigue also leads to brain fog, which means you may struggle to concentrate, think clearly, or remember things. You may also struggle to sleep at night because of pain and other PsA symptoms.  

If you take different approaches, such as improving sleep, avoiding caffeine, alcohol, or nicotine, and getting active, but nothing is working, reach out to your healthcare provider.

There might be another condition, such as anemia (low numbers of healthy red blood cells) or depression, causing your symptoms, or your treatment plan isn’t doing its job. Whatever the case might be, your healthcare provider can help.  

You’re Depressed  

Living with a chronic disease like PsA is exhausting, and various aspects of the condition can affect your mental health. Factors like pain, fatigue, inflammation, trying to keep up with appointments and treatment, lack of support, or feeling alone can cause someone with PsA to become depressed.  

Getting the right treatments for PsA is essential because it slows or stops joint damage, relieves symptoms, and keeps depression in check. And depression can cause PsA symptoms to flare up, which means more inflammation and your treatments not doing what they are supposed to do.  

One of the best things you can do to manage PsA is to reach out to your healthcare provider if you start feeling depressed or struggling to cope. They can tweak your treatment plan to manage symptoms leading to depression, prescribe medicine to help ward off depression, and refer you to a mental health professional. 

How to Switch Treatments  

Trying to figure out what PsA medicines will work for you is a process that requires a lot of patience on your part. If your healthcare provider prescribes a new medication, give it up to three months.

Talk to your healthcare provider about the risks and benefits of a new treatment because it is possible to manage side effects until your body has gotten used to a medication.

For example, if you experience nausea from a new medicine, your healthcare provider might suggest motion sickness pills, which you can get without a prescription, to help with nausea when it occurs.  

Your healthcare provider will want to monitor you to see if a new medication is working correctly. Be sure you keep all appointments and follow through on lab testing that your healthcare provider has requested.  

Lastly, remember that the goal of PsA treatment is remission or very low disease activity. However, it might not be possible to be completely pain- or symptom-free if you have already accumulated joint damage.

Reach out to your healthcare provider if you don’t think a treatment is helping or if you want to try something else. After all, you want to continue to be functional, moving, and thriving.

Psoriatic Arthritis Treatment Options 

You have many treatment options for managing PsA. You will want to work with your healthcare provider to choose treatments that best manage symptoms, stop disease progression, and improve your quality of life.  

Treatment options for PsA include:  

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs are initial treatments for PsA to reduce pain and swelling. Many, including aspirin, Advil (ibuprofen), and Aleve (naproxen sodium), are available over the counter. Your healthcare provider can prescribe stronger NSAIDs if needed.
• DMARDs: These medicines, prescribed by your healthcare provider, can help reduce immune system activity to stop inflammation. By slowing down the immune system, PsA symptoms are managed, and disease progression might be slowed down or stopped. The most commonly prescribed DMARD is Trexall (methotrexate).
• Biologics: Biologic drug therapies are made from biological materials, such as proteins, antibodies, and cells. They mimic the activity of normal immune system cells and processes. Biologics used to treat PsA include Cimzia, Cosentyx (secukinumab), and Taltz (ixekizumab). Because these drugs work by reducing immune function, they might increase your risk for infection.
• Corticosteroids: These powerful anti-inflammatory drugs are prescribed for managing severe pain and swelling. They are given orally or by injection in a joint or muscle. Healthcare providers will only prescribe corticosteroids when you need them because they are linked to severe side effects, including brittle bones, hypertension, and diabetes.
• JAK inhibitors: JAK inhibitors block specific pathways in the immune system response to lower the immune system’s effects. JAK inhibitors approved by the Food and Drug Administration (FDA) for the treatment of PsA include Olumiant (baricitinib), Rinvoq (upadacitinib), and Xelijanz (tofacitinib).
• Otezla (apremilast): This is a newer drug that decreases the activity of an enzyme called phosphodiesterase type 4 (PDE4) to control cell inflammation. It is often prescribed to people with PsA who cannot take DMARDs or biologics.

Summary  

Psoriatic arthritis is a lifelong condition, and part of managing it involves a trial-and-error approach. Because it affects people differently, there is no one solution or strategy for treating PsA that works for everyone.

It is also a progressive disease, which means the way it affects you will change over time, and your treatment plan might stop combating the effects of the disease.

If your treatments stop working or you want to change medications for another reason, your healthcare provider can help. You have many options, including DMARDs, biologics, and JAK inhibitors.

Never stop taking a medicine without your healthcare provider’s approval or advice. If you become pregnant, reach out to your healthcare provider right away so the two of you can discuss treatments that are safest during pregnancy.

A Word From Verywell 

Psoriatic arthritis is a lifelong condition. There is no cure for it, but it is manageable and treatable. It is possible to live a healthy and thriving life with PsA, participate in everyday activities, work, care for your family, and enjoy life. From medications to lifestyle therapies, there are plenty of tools that can make life with PsA easier.  

But early diagnosis and treatment are vital to easing pain and slowing down joint damage. You should also reach out to your healthcare provider anytime you experience new symptoms or if you feel like symptoms aren’t getting better or getting progressively worse.