Table of ContentsView AllTable of ContentsSigns It Isn’t WorkingHow to SwitchTreatment OptionsFrequently Asked QuestionsNext in Psoriatic Arthritis GuidePsoriatic Arthritis Differential Diagnosis: Diseases That Mimic PsA
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Table of Contents
Signs It Isn’t Working
How to Switch
Treatment Options
Frequently Asked Questions
Next in Psoriatic Arthritis Guide
Psoriatic arthritis(PsA) is a type ofinflammatory arthritis.It affects the joints, tendons, and theentheses(the areas where tendons and ligaments meet bone) throughout the body. It occurs in about one-third of the people with the autoimmune skin conditionpsoriasis.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, includingsystemic corticosteroids,disease-modifying antirheumatic drugs(DMARDs),biologics, andJanus kinase (JAK) inhibitors.
This article will cover signs that your treatment plan isn’t working, how to switch treatments, available treatments, and more.
Jacques Hugo / Getty Images
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 causeside 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 atreat-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.
How Long Does It Take for PsA Medications To Start Working?The key to finding a PsA treatment that best works for you is patience. How long it takes for you to see symptom improvement will depend on the drug. For some PsA medicines, you may notice symptom relief in a few weeks. For others, including some biologic drugs and methotrexate, it might take at least three months to see symptom improvement.
How Long Does It Take for PsA Medications To Start Working?
The key to finding a PsA treatment that best works for you is patience. How long it takes for you to see symptom improvement will depend on the drug. For some PsA medicines, you may notice symptom relief in a few weeks. For others, including some biologic drugs and methotrexate, it might take at least three months to see symptom improvement.
You’re Experiencing New Symptoms
If you experience new symptoms, more severe symptoms, and an increase inflare-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:
Joint and bone damageor 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, ongoinginflammation, 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 journalDrugs, 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:
You Can’t Keep Up With Your Dosage
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 tobrain 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 otherPsA 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 asanemia(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 cancause 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.
What to Know About Psoriatic Arthritis (PsA) and Menopause
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 suggestmotion sicknesspills, 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 manytreatment optionsfor 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:
Risks of Untreated PsATreatment for PsA is vital, and untreated PsA can lead to many different health problems, some of which might be life-threatening.Risks of untreated PsA might include:Joint damageDisabilityComorbid (coexisting) conditions like heart disease, hypertension, and diabetesChanges to your vision and other eye troublesDepressionGastrointestinal problems, includinginflammatory bowel disease
Risks of Untreated PsA
Treatment for PsA is vital, and untreated PsA can lead to many different health problems, some of which might be life-threatening.Risks of untreated PsA might include:Joint damageDisabilityComorbid (coexisting) conditions like heart disease, hypertension, and diabetesChanges to your vision and other eye troublesDepressionGastrointestinal problems, includinginflammatory bowel disease
Treatment for PsA is vital, and untreated PsA can lead to many different health problems, some of which might be life-threatening.
Risks of untreated PsA might include:
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.
If you are not improving at the higher dose or you experience severe side effects, your healthcare provider can prescribe a DMARD or a biologic in its place or in combination with methotrexate.
Many medications prescribed for PsA can provide relief from symptoms within a few weeks. It could be up to three months before you see improvement in some cases.It is essential to keep taking your medications once they start to work to continue to have symptom improvement and pain relief and keep down damaging inflammation.
Many medications prescribed for PsA can provide relief from symptoms within a few weeks. It could be up to three months before you see improvement in some cases.
It is essential to keep taking your medications once they start to work to continue to have symptom improvement and pain relief and keep down damaging inflammation.
15 SourcesVerywell 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.Ogdie A, Weiss P.The epidemiology of psoriatic arthritis.Rheum Dis Clin North Am. 2015;41(4):545-568. doi:10.1016/j.rdc.2015.07.001About psoriatic arthritis. National Psoriasis Foundation.Food and Drug Administration.Finding and learning about side effects (adverse reactions).Fabbroni M, Cantarini L, Caso F, et al. Drug retention rates and treatment discontinuation among anti-TNF-α agents in psoriatic arthritis and ankylosing spondylitis in clinical practice.Mediators Inflamm. 2014;2014:862969. doi:10.1155/2014/862969Merola JF, Lockshin B, Mody EA.Switching biologics in the treatment of psoriatic arthritis.Semin Arthritis Rheum. 2017;47(1):29-37. doi:10.1016/j.semarthrit.2017.02.001Dures E, Shepperd S, Mukherjee S, et al.Treat-to-target in PsA: methods and necessity.RMD Open. 2020;6(1):e001083. doi:10.1136/rmdopen-2019-001083Coates LC, Merola JF, Grieb SM, Mease PJ, Callis Duffin K.Methotrexate in psoriasis and psoriatic arthritis.J Rheumatol Suppl. 2020;96:31-35. doi:10.3899/jrheum.200124Chen 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;78(17):1777-1781. doi:10.1007/s40265-018-1009-0Bae YS, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Young M, Bebo B Jr, Kimball AB; National Psoriasis Foundation.Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation.J Am Acad Dermatol. 2012;67(3):459-77. doi:10.1016/j.jaad.2011.07.039Clowse MEB, Scheuerle AE, Chambers C, et al.Pregnancy outcomes after exposure to certolizumab pegol: updated results from a Pharmacovigilance safety database.Arthritis Rheumatol. 2018;70(9):1399-1407. doi:10.1002/art.40508Mathew AJ, Chandran V.Depression in psoriatic arthritis: dimensional aspects and link with systemic inflammation.Rheumatol Ther. 2020;7(2):287-300. doi:10.1007/s40744-020-00207-6UpToDate.Patient education: psoriatic arthritis (beyond the basics).Keskin Y, Nas K, Kiliç E, et al.Clinical characteristics, disease activity, functional status, and quality of life results of patients with psoriatic arthritis using biological and conventional synthetic disease-modifying antirheumatic drugs.Arch Rheumatol.2020;36(1):1-9. doi:10.46497/ArchRheumatol.2021.7874Polachek A, Touma Z, Anderson M, Eder L.Risk of cardiovascular morbidity in patients with psoriatic arthritis: a meta-analysis of observational studies.Arthritis Care Res(Hoboken). 2017;69(1):67-74. doi:10.1002/acr.22926Vlachos C, Gaitanis G, Katsanos KH, Christodoulou DK, Tsianos E, Bassukas ID.Psoriasis and inflammatory bowel disease: links and risks.Psoriasis (Auckl). 2016;6:73-92. doi:10.2147/PTT.S85194
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.Ogdie A, Weiss P.The epidemiology of psoriatic arthritis.Rheum Dis Clin North Am. 2015;41(4):545-568. doi:10.1016/j.rdc.2015.07.001About psoriatic arthritis. National Psoriasis Foundation.Food and Drug Administration.Finding and learning about side effects (adverse reactions).Fabbroni M, Cantarini L, Caso F, et al. Drug retention rates and treatment discontinuation among anti-TNF-α agents in psoriatic arthritis and ankylosing spondylitis in clinical practice.Mediators Inflamm. 2014;2014:862969. doi:10.1155/2014/862969Merola JF, Lockshin B, Mody EA.Switching biologics in the treatment of psoriatic arthritis.Semin Arthritis Rheum. 2017;47(1):29-37. doi:10.1016/j.semarthrit.2017.02.001Dures E, Shepperd S, Mukherjee S, et al.Treat-to-target in PsA: methods and necessity.RMD Open. 2020;6(1):e001083. doi:10.1136/rmdopen-2019-001083Coates LC, Merola JF, Grieb SM, Mease PJ, Callis Duffin K.Methotrexate in psoriasis and psoriatic arthritis.J Rheumatol Suppl. 2020;96:31-35. doi:10.3899/jrheum.200124Chen 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;78(17):1777-1781. doi:10.1007/s40265-018-1009-0Bae YS, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Young M, Bebo B Jr, Kimball AB; National Psoriasis Foundation.Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation.J Am Acad Dermatol. 2012;67(3):459-77. doi:10.1016/j.jaad.2011.07.039Clowse MEB, Scheuerle AE, Chambers C, et al.Pregnancy outcomes after exposure to certolizumab pegol: updated results from a Pharmacovigilance safety database.Arthritis Rheumatol. 2018;70(9):1399-1407. doi:10.1002/art.40508Mathew AJ, Chandran V.Depression in psoriatic arthritis: dimensional aspects and link with systemic inflammation.Rheumatol Ther. 2020;7(2):287-300. doi:10.1007/s40744-020-00207-6UpToDate.Patient education: psoriatic arthritis (beyond the basics).Keskin Y, Nas K, Kiliç E, et al.Clinical characteristics, disease activity, functional status, and quality of life results of patients with psoriatic arthritis using biological and conventional synthetic disease-modifying antirheumatic drugs.Arch Rheumatol.2020;36(1):1-9. doi:10.46497/ArchRheumatol.2021.7874Polachek A, Touma Z, Anderson M, Eder L.Risk of cardiovascular morbidity in patients with psoriatic arthritis: a meta-analysis of observational studies.Arthritis Care Res(Hoboken). 2017;69(1):67-74. doi:10.1002/acr.22926Vlachos C, Gaitanis G, Katsanos KH, Christodoulou DK, Tsianos E, Bassukas ID.Psoriasis and inflammatory bowel disease: links and risks.Psoriasis (Auckl). 2016;6:73-92. doi:10.2147/PTT.S85194
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.
Ogdie A, Weiss P.The epidemiology of psoriatic arthritis.Rheum Dis Clin North Am. 2015;41(4):545-568. doi:10.1016/j.rdc.2015.07.001About psoriatic arthritis. National Psoriasis Foundation.Food and Drug Administration.Finding and learning about side effects (adverse reactions).Fabbroni M, Cantarini L, Caso F, et al. Drug retention rates and treatment discontinuation among anti-TNF-α agents in psoriatic arthritis and ankylosing spondylitis in clinical practice.Mediators Inflamm. 2014;2014:862969. doi:10.1155/2014/862969Merola JF, Lockshin B, Mody EA.Switching biologics in the treatment of psoriatic arthritis.Semin Arthritis Rheum. 2017;47(1):29-37. doi:10.1016/j.semarthrit.2017.02.001Dures E, Shepperd S, Mukherjee S, et al.Treat-to-target in PsA: methods and necessity.RMD Open. 2020;6(1):e001083. doi:10.1136/rmdopen-2019-001083Coates LC, Merola JF, Grieb SM, Mease PJ, Callis Duffin K.Methotrexate in psoriasis and psoriatic arthritis.J Rheumatol Suppl. 2020;96:31-35. doi:10.3899/jrheum.200124Chen 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;78(17):1777-1781. doi:10.1007/s40265-018-1009-0Bae YS, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Young M, Bebo B Jr, Kimball AB; National Psoriasis Foundation.Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation.J Am Acad Dermatol. 2012;67(3):459-77. doi:10.1016/j.jaad.2011.07.039Clowse MEB, Scheuerle AE, Chambers C, et al.Pregnancy outcomes after exposure to certolizumab pegol: updated results from a Pharmacovigilance safety database.Arthritis Rheumatol. 2018;70(9):1399-1407. doi:10.1002/art.40508Mathew AJ, Chandran V.Depression in psoriatic arthritis: dimensional aspects and link with systemic inflammation.Rheumatol Ther. 2020;7(2):287-300. doi:10.1007/s40744-020-00207-6UpToDate.Patient education: psoriatic arthritis (beyond the basics).Keskin Y, Nas K, Kiliç E, et al.Clinical characteristics, disease activity, functional status, and quality of life results of patients with psoriatic arthritis using biological and conventional synthetic disease-modifying antirheumatic drugs.Arch Rheumatol.2020;36(1):1-9. doi:10.46497/ArchRheumatol.2021.7874Polachek A, Touma Z, Anderson M, Eder L.Risk of cardiovascular morbidity in patients with psoriatic arthritis: a meta-analysis of observational studies.Arthritis Care Res(Hoboken). 2017;69(1):67-74. doi:10.1002/acr.22926Vlachos C, Gaitanis G, Katsanos KH, Christodoulou DK, Tsianos E, Bassukas ID.Psoriasis and inflammatory bowel disease: links and risks.Psoriasis (Auckl). 2016;6:73-92. doi:10.2147/PTT.S85194
Ogdie A, Weiss P.The epidemiology of psoriatic arthritis.Rheum Dis Clin North Am. 2015;41(4):545-568. doi:10.1016/j.rdc.2015.07.001
About psoriatic arthritis. National Psoriasis Foundation.
Food and Drug Administration.Finding and learning about side effects (adverse reactions).
Fabbroni M, Cantarini L, Caso F, et al. Drug retention rates and treatment discontinuation among anti-TNF-α agents in psoriatic arthritis and ankylosing spondylitis in clinical practice.Mediators Inflamm. 2014;2014:862969. doi:10.1155/2014/862969
Merola JF, Lockshin B, Mody EA.Switching biologics in the treatment of psoriatic arthritis.Semin Arthritis Rheum. 2017;47(1):29-37. doi:10.1016/j.semarthrit.2017.02.001
Dures E, Shepperd S, Mukherjee S, et al.Treat-to-target in PsA: methods and necessity.RMD Open. 2020;6(1):e001083. doi:10.1136/rmdopen-2019-001083
Coates LC, Merola JF, Grieb SM, Mease PJ, Callis Duffin K.Methotrexate in psoriasis and psoriatic arthritis.J Rheumatol Suppl. 2020;96:31-35. doi:10.3899/jrheum.200124
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;78(17):1777-1781. doi:10.1007/s40265-018-1009-0
Bae YS, Van Voorhees AS, Hsu S, Korman NJ, Lebwohl MG, Young M, Bebo B Jr, Kimball AB; National Psoriasis Foundation.Review of treatment options for psoriasis in pregnant or lactating women: from the Medical Board of the National Psoriasis Foundation.J Am Acad Dermatol. 2012;67(3):459-77. doi:10.1016/j.jaad.2011.07.039
Clowse MEB, Scheuerle AE, Chambers C, et al.Pregnancy outcomes after exposure to certolizumab pegol: updated results from a Pharmacovigilance safety database.Arthritis Rheumatol. 2018;70(9):1399-1407. doi:10.1002/art.40508
Mathew AJ, Chandran V.Depression in psoriatic arthritis: dimensional aspects and link with systemic inflammation.Rheumatol Ther. 2020;7(2):287-300. doi:10.1007/s40744-020-00207-6
UpToDate.Patient education: psoriatic arthritis (beyond the basics).
Keskin Y, Nas K, Kiliç E, et al.Clinical characteristics, disease activity, functional status, and quality of life results of patients with psoriatic arthritis using biological and conventional synthetic disease-modifying antirheumatic drugs.Arch Rheumatol.2020;36(1):1-9. doi:10.46497/ArchRheumatol.2021.7874
Polachek A, Touma Z, Anderson M, Eder L.Risk of cardiovascular morbidity in patients with psoriatic arthritis: a meta-analysis of observational studies.Arthritis Care Res(Hoboken). 2017;69(1):67-74. doi:10.1002/acr.22926
Vlachos C, Gaitanis G, Katsanos KH, Christodoulou DK, Tsianos E, Bassukas ID.Psoriasis and inflammatory bowel disease: links and risks.Psoriasis (Auckl). 2016;6:73-92. doi:10.2147/PTT.S85194
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