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3 Reasons You May Need to Change Your Psoriatic Arthritis Treatment
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When you’re newly diagnosed with psoriatic arthritis and prescribed medication, know there’s a good chance your treatment plan may need to change before too long.
The first few months after a psoriatic arthritis diagnosis can be tricky as you and your doctor figure out which medications are most effective for you. It’s often a trial-and-error process that may involve starting a new medication or adding one to your treatment regimen.
“The start of psoriatic arthritis treatment is the most trying time,” says Elyse Rubenstein, MD, a rheumatologist at Providence Saint John’s Health Center in Santa Monica, California. “You’re trying to find out what will put you in remission. But even after you’re in remission, there’s a chance the disease could flare and you could need to switch medications again.”
There's no set treatment for psoriatic arthritis — the medication that works well for one person might not be effective for someone else. Even the medication that worked for you in the past might not be as effective in a few months.
One study, published in August 2014 in the journalArthritis Research & Therapy, found that 69 percent of people with psoriatic arthritis who started their treatment with a nonbiologic disease-modifying anti-rheumatic drug (DMARD), such as methotrexate or sulfasalazine, altered their medication regimen within a year. About 45 percent of those who took biologic drugs like infliximab and adalimumab did the same.
Which Psoriatic Arthritis Medication Is Right for You?
When you’re first diagnosed with psoriatic arthritis, your doctor will take several things into account when deciding which medication to recommend. A major consideration is the severity of your symptoms, Dr. Rubenstein says.
If you can manage your pain with an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen, you might not need prescription medication, she says. If an NSAID isn’t enough, another option could be a nonbiologic DMARD like methotrexate. For severe symptoms, a biologic drug — a newer type of DMARD — could be the answer.
If you have other health conditions, your doctor will also take those into consideration. For example, people with congestive heart failure or those who have a family history of demyelinating diseases, such as multiple sclerosis and Guillain-Barre syndrome, may want to avoid certain biologic medications, Rubenstein says.
Other considerations include any medication allergies you may have and your level of comfort with nonoral drugs. Many psoriatic arthritis medications are given via injection or intravenously.
When Your Treatment Plan May Be Adjusted
There are several reasons your doctor may recommend changing your psoriatic arthritis medication regimen, including:
The medication isn’t working. If you’re taking a medication and still experiencing psoriatic arthritis symptoms, it might be time to try something else. “Are you able to carry out the activities of daily living? Are you able to go to work?” Rubenstein asks. “Daily function is one of the things to look at.”
In some cases, your doctor may recommend that you continue taking your current medication and try adding another. Research has shown this to be effective for some people. A study published in September 2013 in the journalClinical Therapeuticsfound that people with psoriatic arthritis who took both nonbiologic DMARDs and biologic drugs discontinued their medications at a lower rate than those who used biologics alone.
You're experiencing side effects. Some psoriatic arthritis medications may cause side effects that are bothersome enough to stop taking them. Side effects may include gastrointestinal irritability, nausea, headaches, and rashes, Rubenstein says. People who take a medication that suppresses the immune system may develop an infection, making it necessary to stop the drug. A study published in July 2014 in the journalMediators of Inflammationfound that almost 40 percent of people who discontinued their biologic drugs during the study did so because of side effects. However, medications should never be stopped without first consulting your doctor, who can determine the cause of your side effects and adjust your treatment plan accordingly.
You're not taking the drug properly. It’s common for people to not follow a medication schedule recommended by their doctor. Simple forgetfulness is one of the biggest reasons for improper dosing of psoriasis and psoriatic arthritis medications, according to a study published in the journal Cutis in November 2013. If you find this happening to you, it might be better to switch to a treatment that’s easier for you to stick with or ask your doctor about ways to help you better adhere to your medication schedule.
Psoriatic Arthritis Treatment: A Long-Term Process
When you’re trying to figure out which psoriatic arthritis medications work best for you, patience is key, Rubenstein says. “How long you need to wait depends on the medication,” she says. “If you’re trying a biologic drug, you should give it about three months. For methotrexate in particular, give it three months at a minimum to start to work.”
Talk to your doctor about the risks and benefits of your treatment. A study published in December 2019 inClinical Rheumatologyfound that some people with mild psoriatic arthritis symptoms were willing to risk relapse rather than suffer from medication side effects such as severe sickness and nausea
People with psoriatic arthritis should also remember that the goal of treatment is remission — meaning no arthritis pain and the ability to perform tasks like walking, working, and exercising with little or no trouble. If a medication alleviates only some of your pain, it’s not working properly.
“You want to be functional,” Rubenstein says. “Some people might have five minutes of morning stiffness but then they’re fine, and that’s OK. But if you’re having three hours of morning stiffness every day, something’s wrong.”
Additional reporting by Beth W.
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