Table of ContentsView AllTable of ContentsPsoriatic ArthritisTypes of BiologicsWhat To ExpectRisks/Side EffectsGetting StartedHealth DisparitiesOther Considerations
Table of ContentsView All
View All
Table of Contents
Psoriatic Arthritis
Types of Biologics
What To Expect
Risks/Side Effects
Getting Started
Health Disparities
Other Considerations
This article delves into whether biologics make sense for you, how they work, and how to get started.
Verywell / Zoe Hansen
Basics of Psoriatic Arthritis
PsA is a type ofinflammatory arthritisthat often affects people who already have the inflammatory skin conditionpsoriasis.
Psoriasis is known for causing patches of red, inflamed skin with white, silvery flakes. PsA affects up to 30% of people with psoriasis.
Joint pain, stiffness, and swelling are the main symptoms of PsA. These symptoms can affect any part of the body, including the fingers and spine, and symptoms range from mild to severe.
PsA, much like psoriasis, causes periods of flare-ups (high disease activity) and periods of remission (reduced or no symptoms).
There’s no cure for PsA. Healthcare providers focus on controlling symptoms and preventing joint damage. Without treatment, PsA can lead to permanent damage and disability.
Comorbidities in Psoriasis
Biologics are a type ofdisease-modifying anti-rheumatic drug(DMARD) designed to manage PsA symptoms and slow downPsA disease progression.
Researchers consider biologic drugs to be the most targeted therapies for treating PsA.
Traditional DMARDs, like methotrexate, suppress the entire immune system. Biologics only target parts of the immune system that are linked to PsA. This includes immune cells and inflammatory proteins such as:
These cells and proteins play a significant part in the development and progression of PsA and psoriasis.
Types of Biologics for PsA
Many biologic drugs can treat PsA. Each type of biologic targets a different pathway thought to promote the disease.
Your healthcare provider will look at your overall health, lifestyle, and severity of your disease to decide which biologic might be best for you.
The types of biologics available for treating PsA include:
Your healthcare provider is in the best position to tell you whether you might benefit from biologic treatment. In general, these drugs are prescribed to people with moderate to severe PsA.
They’re also prescribed when other treatments haven’t worked, or when you cannot take other treatments because of side effects or for some other reason.
An Overview of Biologics for Treating Psoriatic Disease
Biologics are administered either through injection or using an IV infusion (intravenously using a needle directly into the arm).
Injections
Many of the biologic drugs approved for treating psoriatic arthritis are injected subcutaneously (under the skin).Subcutaneous injectionsare given in areas where you can pinch the skin, i.e., the abdomen or thighs.
Injections you can give yourself at home either come as a single-use syringe or a pen-like auto-injector. There are also powdered formulas in single-use vials. But because these require exact amounts of sterile water, they are often only used in medical settings.
Dosages for biologic injections will be different based on the drug you’re taking. Some are given once or twice a week, some are once every other week, and others are once a month.
If you have questions about your dosage schedule, talk to your provider or pharmacist.
Infusions
Biologic infusions used to treat PsA include Remicade andSimponi. These medications are given through an IV drip into a vein.
An infusion appointment can take two or more hours to complete. Typically, infusion treatments are done every few weeks.
When you arrive to get your infusion, the clinician will place an IV into your vein, connected to a thin tube. Once the IV is placed, the clinician will start the infusion, and the medicine will move through the thin tube into your vein.
Make sure you feel well when you show up for an infusion appointment. This is to protect yourself and others who might also beimmunocompromised(having a weak immune system).
Most biologic treatments weaken your immune system. If you have an infection that is starting, having an infusion can make it worse.
After your first infusion, you will be monitored for up to an hour for any signs of anallergic reaction—swollen lips, shortness of breath, rash, etc. You’ll get information about what side effects to watch out for and who to contact about them.
The effects of a PsA biologic begin a few weeks after the initial treatment.After you have had a few infusions, you will start to see the full effects, which can last for several months.
Talk to your healthcare provider about how you can best manage symptoms until your infusion treatments take effect.
Biologics Doctor Discussion GuideGet our printable guide for your next doctor’s appointment to help you ask the right questions.Download PDFEmail AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Get our printable guide for your next doctor’s appointment to help you ask the right questions.
Download PDF
Email AddressSign UpThank you, {{form.email}}, for signing up.There was an error. Please try again.
Sign Up
Thank you, {{form.email}}, for signing up.
There was an error. Please try again.
Risks and Side Effects
All treatments come with risks and benefits, and these should be weighed carefully before starting a new treatment.
Your healthcare provider is in the best position to explain all the pros and cons of biologic therapy for PsA and which drug might be best for your unique situation.
The most common side effects of biologics used for PsA include:
These side effects are generally mild. More serious side effects are rare. They include:
How Biologic Therapy Works
It’s typical to try traditional DMARDs like methotrexate before starting on a biologic. Biologics are expensive drugs. Some insurance companies won’t cover them unless traditional therapies have failed.
To see whether your’e a candidate for biologics, your healthcare provider will do a full assessment of your health, including your medical history, a physical exam, bloodwork, and other tests.
Let them know about other medications you are taking and take any vitamins and supplements. Some medications and supplements may interact with biologics.
You should hold off on starting a biologic when you are sick, even if it is as simple as thecommon cold. This is because biologic therapy impairs the immune system and increases infection risk.
Some mandatory steps must be taken before you start on a biologic:
Once you start a biologic, you are not only at greater risk for infection, but ineligible to receivelive vaccinessuch asvaricellaand MMR (measles, mumps, and rubella) due to health risks.Getting your vaccines before starting the medication allows you to get protection from certain diseases before you are no longer able to.
Once you start biologic therapy, check with your healthcare provider before getting any routine vaccines.
Talk to your provider about your risk for certain types of cancer. Some research has linked biologic drugs with an increased risk forskin cancersandlymphoma.This risk shouldn’t stop you from starting biologics, but you may need to be monitored while taking them.
According to a 2015 study involving urban health institutions, Black people with PsA are far less likely to be prescribed biologics than White people. In fact, 46.2% of White people got biologics, compared to 13.3% of Black people.
Researchers said that lack of access to biologic drugs led to more severe disease, greater psychological impact, and lower quality of life.
A 2013 study showed South Asian Americans with PsA are also less likely to be treated with biologics than those with European ancestry. This study also found disparities in the treatment of Black people.
Additional Considerations
Your experience on biologic drug therapy for PsA will be different than someone else’s. There will be several things to consider as you start biologic therapy and as you continue the course.
Improvement Takes Time
It may take three or more months of biologic treatment to feel less pain and have symptom improvement from PsA.However, studies have found biologics can offer mood improvements in a shorter time.
This is important because people with PsA have a higher risk for depression and a depressed mood can worsen pain perception.That means the sooner you feel better mentally and emotionally, the sooner you’ll feel better physically.
Drug Costs
Biologics are expensive. They can cost anywhere from $10,000 to $30,000 a year.
If you have insurance, your provider will work with your carrier to find a biologic that’s covered.
If you’re not insured or your insurances leaves you with a large share of the cost, look into drug manufacturers' patient assistance programs. They can reduce costs so you can have access to the drug your healthcare provider chooses.
Managing Flares
Even on biologics, you might still experienceflare-ups—periods where symptoms are worse than usual. Flare-ups are unpredictable—you might feel fine one day and the next, you are struggling to get out of bed.
If you are experiencing frequent flare-ups or short breaks between flares, you might want to talk to your healthcare provider about whether your biologic is helping or whether it is time to start a different biologic for treating PsA.
Your biologic may not always be the reason you are experiencing flare-ups. PsA is associated with triggers—disease and lifestyle patterns that trigger symptoms. This might include things like cold weather, stress, diet, smoking, and overconsumption of alcohol.
Doing what you can to avoid triggers can pay off in the form of less pain, fewer symptoms, and improved quality of life.
Prioritizing Mental Health
Prioritizing your mental health can also help. Research shows people with PsA have a higher risk for depression and anxiety.And people who struggle to cope are more likely to experience PsA flare-ups.
Do what you can to invest in your mental health and better learn to cope with the many aspects of living with PsA, includingjoint and skin painand fatigue.
You should also make sure you are making healthy lifestyle choices, including:
An Overview of Psoriatic Arthritis Triggers
Sticking To Your Treatment Plan
Treating PsA takes a lot of work, and it can be hard to keep up with all the aspects of your care. The Psoriasis Foundation says the main reason PsA treatments fail is that people don’t stick to them properly.
Biologic therapy comes with some challenges, including high costs, fear of side effects, not feeling better quickly enough, or the timing of treatment might be inconvenient. It is also not uncommon for people to feel wary of biologics.
But your healthcare provider has prescribed biologic drug therapy because they have determined the benefits outweigh the risks. And, fortunately, most of the newer biologics are effective and safe to use.
Stopping treatment, regardless of the reason, is never a good idea. You will likely find yourself with increased PsA symptoms and flares as soon as you stop using your biologic or other treatments. The decision to stop or reduce treatment should be made between you and your provider.
Summary
Biologic drugs for psoriatic arthritis target various components of the inflammation response. The goal is to stop inflammation, relieve symptoms, and prevent further damage. They are usually considered after first trying other treatments.
A Word From Verywell
It is also important to go to all regular follow-up medical visits to make sure your biologic is still working. When you see your medical provider, be sure to tell them about any problems or side effects you are experiencing.
15 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Mease PJ, Gladman DD, Papp KA, et al.Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics.J Am Acad Dermatol. 2013 Nov;69(5):729-735. doi:10.1016/j.jaad.2013.07.023
National Psoriasis Foundation.Biologics.
van den Bemt BJF, Gettings L, Domańska B, et al.A portfolio of biologic self-injection devices in rheumatology: how patient involvement in device design can improve treatment experience.Drug Deliv. 2019;26(1):384-392. doi:10.1080/10717544.2019.1587043
Arthritis Foundation.Biologics.
Melsheimer R, Geldhof A, Apaolaza I, Schaible T. Remicade® (infliximab): 20 years of contributions to science and medicine.Biologics.2019;13:139-178. Published 2019 Jul 30. doi:10.2147/BTT.S207246
Henrickson SE, Ruffner MA, Kwan M.Unintended immunological consequences of biologic therapy.Curr Allergy Asthma Rep. 2016;16(6):46. doi:10.1007/s11882-016-0624-7
Kane SV.Preparing for biologic or immunosuppressant therapy.Gastroenterol Hepatol (N Y). 011;7(8):544-546.
Papp KA, Haraoui B, Kumar D, et al.Vaccination guidelines for patients with immune-mediated disorders on immunosuppressive therapies.J Cutan Med Surg. 2019;23(1):50-74. doi:10.1177/1203475418811335
Geller S, Xu H, Lebwohl M, Nardone B, et al.Malignancy risk and recurrence with psoriasis and its treatments: a concise update.Am J Clin Dermatol. 2018;19(3):363-375. doi:10.1007/s40257-017-0337-2
Kerr GS, Qaiyumi S, Richards J, et al.Psoriasis and psoriatic arthritis in African-American patients–the need to measure disease burden.Clin Rheumatol. 2015;34(10):1753-1759. doi:10.1007/s10067-014-2763-3
National Psoriasis Foundation.Living with psoriatic arthritis.
Chen BK, Yang YT, Bennett CL.Why biologics and biosimilars remain so expensive: despite two wins for biosimilars, the Supreme Court’s recent rulings do not solve fundamental barriers to competition.Drugs. 2018 Nov;78(17):1777-1781. doi:10.1007/s40265-018-1009-0
Husni ME, Merola JF, Davin S.The psychosocial burden of psoriatic arthritis.Semin Arthritis Rheum. 2017 Dec;47(3):351-360. doi:10.1016/j.semarthrit.2017.05.010
National Psoriasis Foundation.How to stick with your treatment plan.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.Cookies SettingsAccept All Cookies
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.
Cookies SettingsAccept All Cookies
