Oral Medications Used to Treat Psoriatic Arthritis

Psoriatic arthritis (PsA) is arthritis that can affect people with psoriasis. It can cause long-term damage to joints. There are a lot of medication choices available to treat PsA. Some of these medications are injections, and others are pills. 

Read on to learn more about the oral medications used to treat PsA.

What oral medications are used to treat psoriatic arthritis?

There’s no cure for PsA. But medications are used to lessen pain and prevent joint damage. The medications your healthcare provider chooses for you will depend on what joints are involved and the severity of your symptoms. 

You may need to try a few different medications before finding one that works for you. Below are some commonly used oral options.

NSAIDs

While they aren’t specifically FDA-approved for PsA, non-steroidal anti-inflammatory drugs (NSAIDs) are often used to help with mild arthritis symptoms. Many NSAIDs are available over-the-counter (OTC) and are inexpensive. But other NSAIDs and higher strength products require a prescription. Commonly used NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve).

NSAIDs can help relieve pain and lessen swelling. This can make it easier for people with PsA to move, especially in the morning. But NSAIDs can cause stomach irritation, heart problems, and kidney problems. 

DMARDs

Another class of medications commonly used to treat PsA is disease-modifying antirheumatic drugs (DMARDs). DMARDs are used in mild to moderate PsA. Most DMARDs are prescribed off-label to treat PsA. That means they’re used in a way that’s not approved by the FDA.

These medications include:

• Methotrexate (Trexall, Otrexup)

• Sulfasalazine (Azulfidine)

• Leflunomide (Arava)

• Cyclosporine (Neoral)

DMARDs lessen inflammation by quieting down your immune system. Some DMARDs work for both psoriasis and arthritis. Like NSAIDS, DMARDs can help lessen pain and swelling. But they also slow PsA from getting worse and/or affecting other parts of your body.

Rayos

Rayos (prednisone delayed-release) is an oral corticosteroid that’s FDA-approved for active PsA and maintenance treatment of PsA. It’s been used for decades to treat a lot of different medical conditions. 

What’s different about Rayos is that it releases the medication 4 hours after you take it. The cells involved in inflammation are most active between 2 AM and 8 AM. The delayed release of Rayos lets you take the medication before going to bed so it can do its work when it can be most effective. 

The dose you take of Rayos depends on your symptoms and what medications you were taking before. This usually ranges from 5 mg to 60 mg every day. Rayos should be taken with food. And the tablets should be swallowed whole, not cut or chewed. 

Common side effects while taking Rayos are:

• Water retention

• High blood pressure

• High blood sugar

• Weight gain and greater appetite

• Behavior and mood changes

Other more severe side effects with Rayos are:

• Greater risk of infection

• Tears in the stomach or intestine

• Eye problems

• Lower bone density (raises the risk of broken bones)

Let your healthcare provider know right away if you’re having any of these symptoms.

Taking Rayos while pregnant can cause harm to an unborn baby. And it’s not known if it’s safe to nurse while taking Rayos. Talk with your healthcare provider to learn more about this.

It’s important that you follow your healthcare provider’s instructions when taking Rayos.  Don’t stop taking it suddenly. Your healthcare provider will tell you how to safely lower your dose over time. 

Otezla

Otezla (apremilast) is a newer oral medication FDA-approved to treat PsA. Otezla stops the production of an enzyme (protein) that’s involved in inflammation. Without this enzyme, inflammation and other PsA symptoms can be greatly reduced. 

Otezla comes in 10 mg, 20 mg, and 30 mg tablets. You’ll slowly raise your dose over the course of 5 days to a target dose of 30 mg twice a day.  People with kidney problems will need to take a lower dose. 

It can take some time for your symptoms to improve while taking Otezla — sometimes at least 4 months. But even if it provides relief, it’s a medication you keep taking even when you don’t have symptoms. 

Like all medications, Otezla can cause some side effects. The most common ones include diarrhea, nausea, and headache.

Otezla can also cause some severe side effects. This can include severe diarrhea, vomiting, and nausea, usually within the first few weeks of starting the medication. Some people have reported depression while taking Otezla. Weight loss has also occurred.

Many people don’t get any side effects while taking Otezla. The minor side effects usually go away after taking it for a few weeks. Tell your healthcare provider right away if you notice any mood or behavior changes, unexplained weight loss, or other severe side effects.

Xeljanz

Xeljanz (tofacitinib) belongs to a class of medications called janus kinase (JAK) inhibitors. JAK inhibitors work inside your cells to stop inflammation. Xeljanz is FDA-approved to treat active PsA. It’s typically taken together with a DMARD like methotrexate. It can help reduce swelling and lessen joint pain. 

Xeljanz is a pill that comes in two forms, Xeljanz XR and Xeljanz. If you’re taking Xeljanz XR, you’ll take one 11 mg tablet every day. If you’re taking Xeljanz, you’ll take one 5 mg tablet twice a day. Your dose will be lower if you have liver or kidney problems, or if you’re taking certain medications. 

The time it takes for Xeljanz to work is different for each person. Studies show that some people feel relief from joint pain and swelling 2 weeks after starting Xeljanz. For others, it can take 3 months or more. 

Common side effects in people taking Xeljanz include:

• Upper respiratory tract infections  

• Headache 

• Diarrhea

• Common cold

Xeljanz also has several boxed warnings, the strongest warning the FDA gives to medications. These serious side effects were studied in people taking Xeljanz for rheumatoid arthritis. But it’s possible that they could also happen in people taking Xeljanz for PsA.

These boxed warnings include a greater risk of:

• Serious infections

• Cancer

• Heart attack, stroke, or death

• Blood clots, including in the lungs

Other serious side effects include severe allergic reactions, tears in the stomach or intestine, and changes in bloodwork.

Xeljanz can make it harder for women to get pregnant. More information is needed about this.  We don’t know if stopping Xeljanz changes this. And we don’t know if Xeljanz is safe for an unborn baby if you become pregnant. 

People respond differently to medications. Talk to your healthcare provider to see if the benefits of taking Xeljanz outweigh the risks for you.

When are oral medications typically used in treating psoriatic arthritis?

In addition to the oral medications described above, injectable medications (called biologics) are often used to treat PsA. The type of medication your healthcare provider chooses for you depends on factors like symptom severity, medical history, and your preferences.

Current guidelines recommend injectable medications called TNF-alpha inhibitors as first-choice treatment. But your healthcare provider may decide to start with an oral medication, like methotrexate, instead. That’s because oral medications tend to be less expensive. 

In some cases, your healthcare provider might switch you to an oral medication (e.g., Xeljanz) if a TNF-alpha inhibitor isn’t working well for you.

You may have to try a few different medications before you find one that works for you. And you may need to take more than one medication to get relief from your symptoms. 

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Written by:

Rebecca Liggon, PharmD

Rebecca Liggon is a clinical pharmacist in Madison, Wisconsin. She holds a bachelor’s degree in pharmacy from the University of Wisconsin-Madison and a doctorate degree in pharmacy from the University of Colorado Health Sciences Center.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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