Disease-modifying anti-rheumatic drugs (DMARDs) are essential in treating psoriatic arthritis (PsA). They help reduce inflammation, slow joint damage, and alleviate symptoms like pain and stiffness. If your doctor has prescribed a DMARD, you might be wondering about its function, effectiveness, and potential side effects. Here’s a comprehensive overview.
How DMARDs Work for Psoriatic Arthritis
DMARDs are known as immunosuppressants or immunomodulators because they alter the immune system’s activity. In psoriatic arthritis, the immune system mistakenly attacks healthy tissues, causing inflammation. DMARDs target inflammatory pathways to control this inflammation, differentiating them from over-the-counter medications like non-steroidal anti-inflammatory drugs (NSAIDs) by not only relieving symptoms but also slowing disease progression.
Types of DMARDs Used for Psoriatic Arthritis
Traditionally, DMARDs for psoriatic arthritis have included conventional systemic drugs such as methotrexate. However, newer classes of medications, such as biologics (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) like apremilast and tofacitinib, have emerged. According to Dr. Laura Coates, an associate professor and psoriatic arthritis researcher at the University of Oxford, these newer drugs are similar to biologics in terms of cost, novelty, and effectiveness.
Common conventional DMARDs for psoriatic arthritis include:
- Arava (leflunomide)
- Azulfidine (sulfasalazine)
- Cyclosporine and Tacrolimus (calcineurin inhibitors)
- Rheumatrex, Trexall, Rasuvo, Otrexup (methotrexate)
- Choosing the Right DMARD for Your Psoriatic Arthritis
Selecting the appropriate DMARD involves close collaboration between you and your healthcare provider. According to Dr. Elizabeth Schulman of the Hospital for Special Surgery and Weill Cornell Medical College, biologics are often the first line of treatment for PsA, with methotrexate used primarily when biologics are contraindicated due to side effects or comorbidities.
The choice of medication may also depend on specific disease characteristics. For example, methotrexate is not approved for axial disease (spine inflammation). Costs and patient preferences also play a role; conventional DMARDs are typically less expensive than biologics and can be taken as pills, which is preferable for those uncomfortable with injections. Dr. Schulman notes that while DMARDs are not the usual standard of care, they remain an important option.
Side Effects of DMARDs
DMARDs, like all medications, come with potential side effects. Dr. Coates highlights that these drugs can suppress the immune system, increasing infection risk. Other possible side effects include:
- Abnormal blood counts
- Diarrhea
- Dizziness
- Elevated liver function tests
- Gastrointestinal upset
- Hair loss
- Hypertension
- Mouth sores
- Rash
What if Your DMARD Isn’t Working?
If your DMARD isn’t providing relief or is causing side effects, consult your provider. Adjustments in dosage or timing, or the addition of supplements like folate, may help. The National Psoriasis Foundation suggests that if you don’t see improvement within three months, it’s time to discuss alternative treatments with your doctor. Fortunately, many therapeutic options are now available for psoriatic arthritis.
Key Takeaways
DMARDs have been a cornerstone in psoriatic arthritis treatment for many years. While newer medications like bDMARDs and tsDMARDs have expanded the treatment landscape, traditional DMARDs remain well-understood and widely used. If a prescribed DMARD isn’t effective, options for changing or adding treatments are available. Work closely with your provider to understand the benefits and risks of all medications to determine the best treatment plan for you.
