How DMARDs and Biologics Work to Treat Psoriatic Arthritis

Treatment for psoriatic arthritis, or PsA, differs from person to person. Someone with mild PsA may be able to relieve their joint pain with lifestyle changes and over-the-counter pain relievers. 

When those aren’t enough, medications known as DMARDs (disease-modifying antirheumatic drugs) and/or biologics may be appropriate.

What are DMARDs?

DMARDs suppress and change how the immune system works to stop the inflammatory response. By reducing or preventing this inflammation, these medications reduce symptoms and long-term joint damage. 

Versions of DMARDs have been around since the 1930s — when patients literally used injectable gold to treat their rheumatic diseases. (“Gold therapy” is still available today, although rarely used due to its negative side effects.) 

Since then, many different agents have become available to help provide the most relief with the fewest side effects. They fall into two main categories: 

• Conventional, non-biologic DMARDs: One of the most common options in this category is methotrexate. 

• Biologic DMARDs: These are a newer category that are more targeted than conventional DMARDs.

What are the treatment goals of DMARDs and biologics for psoriatic arthritis?

The goals of DMARDs and biologics are to:

• Decrease the underlying inflammation to relieve symptoms

• Prevent long-term joint damage

• Slow the progression of psoriatic arthritis disease overall

• Achieve and maintain a state of remission

• Improve mobility, range of motion, and quality of life

DMARDs — especially biologics — tend to be very effective for the people who are eligible for them. They also have fewer side effects than previous treatments for psoriatic arthritis. However, DMARDs and biologics can have more long-term health risks than less aggressive therapies.

What’s the difference between biologics and other DMARDs?

Biologics are a subcategory of DMARDs. They target very specific parts of the immune system that produce inflammatory proteins. Because they’re more targeted than conventional DMARDs, they are often more effective. They also tend to have fewer side effects.

There are many types of biologics that can help treat psoriatic arthritis. You may need to try more than one before you find the right fit. Some types of biologics include:

• TNF inhibitors

• Interleukin inhibitors

• T-cell inhibitors

What is the treatment schedule for biologic therapy for psoriatic arthritis?

Biologics are typically delivered via:

• Injection, which you can often do at home

• Infusion, which is generally done by a healthcare professional in a clinic 

Some people are nervous to start biologic therapy because it involves needles. The good news is that most people taking biologics generally get used to injections and infusions after a couple doses. There are also many tips to face your fear of needles and make the experience more comfortable.

Plus, there are benefits to this type of therapy. You often need to take oral pills on a daily basis, which can be inconvenient and hard to remember. Skipping or missing one could result in a flare. 

Biologic injections and infusions may be administered as little as once every three months. This may be easier and more convenient for people who have a hard time remembering to take a daily pill.

How do I know if DMARDs and biologics are right for my psoriatic arthritis?

DMARDs and biologics are for people who have moderate-to-severe disease. This means you may have multiple affected joints and/or psoriasis plaques covering large portions of your body. It may also be a good option for people who have not found relief from other treatments.

Talk to your doctor to find out if this class of medications is right for you. They can give you more information about the risks and benefits of DMARDs based on your personal health factors.