Dr. Ahmed Psoriatic Arthritis is an autoimmune disease. It affects people who have psoriasis, a chronic skin and nail disease. In psoriatic arthritis, the joints become swollen and painful.
Here is a list of medications used to treat psoriatic arthritis based on their mechanism of action, date of approval, and important contraindications:
Class | Medicines |
| NSAIDs | Indomethacin Ibuprofen Naproxen Diclofenac |
| DMARDs, Immunosuppressants | Methotrexate Sulfasalazine Cyclosporin Lefluonamide Apremilast |
| TNF Inhibitors | Etanercept Infliximab Adalimumab Golimumab Certolizumab |
| Interleukin inhibitors | Ustekinumab Guselkumab Ixekizumab Secukinumab |
| CTLA4-immunoglobulin | Abatacept |
| Janus Kinase Inhibitors | Tofacitinib |
List of NSAIDs used to treat Psoriatic Arthritis:
NSAIDs (non-steroidal anti-inflammatory drugs) are used to relieve pain and inflammation in the joints.
NSAIDs are commonly used as reliever medicines rather than controlling the disease.
Indomethacin for psoriatic arthritis: |
| Generic Name: Indomethacin Trade Name: Indocin Company Name: Mediceena pharma (PVT) LTD. Date of approval: – MOA: Inhibits prostaglandin formation in bodily tissues by inhibiting at least two cyclo-oxygenases (COX) isoenzymes, COX-1 and COX-2. It may reduce pro-inflammatory cytokine activity, block neutrophil aggregation, change lymphocyte activity, and inhibit chemotaxis; these outcomes may help with anti-inflammatory activity. Uses: Indocin is used to alleviate the pain, stiffness, and discomfort produced by psoriatic arthritis. Major contraindications:Neonates
Absolute
Relative
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Ibuprofen for Psoriatic arthritis |
| Generic Name: Ibuprofen Trade Name: Motrin IB, Advil, Neoprofen Company Name: Pfizer Inc. Date of approval: – MOA: Inhibits prostaglandin formation in bodily tissues by inhibiting at least two cyclo-oxygenases (COX) isoenzymes, COX-1 and COX-2. It may block chemotaxis, modify lymphocyte activity, decrease proinflammatory cytokine activity, and inhibit neutrophil aggregation; these effects may contribute to anti-inflammatory efficacy. Uses: It is used to alleviate pain associated with conditions like psoriatic arthritis, rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis when taken orally. Major contraindications:
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Naproxen for Psoriatic Arthritis |
| Generic Name: Naproxen Trade Name: Naprosyn, Naprelan, Aleve, Anaprox Company Name: Bayer HealthCare Date of approval: February 17, 2006 MOA: Naproxen inhibits both cyclooxygenase (COX) isoenzymes, COX-1 and COX-2, competitively, resulting in analgesic and anti-inflammatory actions. Uses: It is used in the therapy of psoriatic arthritis, rheumatoid arthritis, osteoarthritis, or juvenile arthritis. Major contraindications:Absolute
Relative
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Diclofenac for Psoriatic Arthritis |
| Generic Name: Diclofenac Trade Name: Zorvolex, Cambia Company Name: GlaxoSmithKline (GSK) Date of approval: – MOA: Inhibits cyclooxygenase (COX)-1 and COX-2, consequently inhibiting prostaglandin production. It may also suppress neutrophil aggregation/activation, chemotaxis, proinflammatory cytokine levels, and alter lymphocyte activity. Uses: It is used to treat psoriatic arthritis, rheumatoid arthritis, and osteoarthritis. Major contraindications:
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Oral Small Molecules: Immunosuppressants, DMARDs for Psoriatic Arthritis:
DMARDs (disease-modifying anti-rheumatic drugs are the usual first-line drugs added to the treatment regimen of patients with active psoriatic arthritis.
DMARDs can be combined with NSAIDs and biological agents like TNF inhibitors in patients who do not adequately respond to monotherapy alone.
Methotrexate for Psoriatic Arthritis: |
| Generic Name: Methotrexate Trade Name: Trexall, Otrexup Company Name: Pfizer Laboratories LTD. Date of approval: February 26, 1999 MOA: Methotrexate is a disease-modifying antirheumatic drug used to treat psoriatic arthritis. It works by blocking the metabolism of folic acid, leading to the inhibition of DNA synthesis and cell growth. Methotrexate also reduces the production of cytokines, signaling molecules that play a role in the inflammatory response. This helps to reduce inflammation and improve the symptoms of psoriatic arthritis. Uses: It is used for the therapy of psoriatic arthritis, rheumatoid arthritis, and any other inflammatory joint condition. Major contraindications:
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Sulfasalazine for Psoriatic Arthritis: |
| Generic Name: Sulfasalazine Trade Name: Azulfidine, Azulfidine EN Company Name: Pfizer Laboratories LTD. Date of approval: – MOA: Sulfasalazine is a prodrug that is broken down into its active ingredients, sulfapyridine and 5-aminosalicylic acid (5-ASA; mesalamine); the anti-inflammatory characteristics of 5-ASA, which blocks the formation of leukotriene and lipoxygenase, are primarily responsible for the beneficial effects. Uses: Psoriatic arthritis, spondyloarthropathies including IBD-associated arthritis Major contraindications:
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Cyclosporine or Ciclosporin for Psoriatic Arthritis: |
| Generic Name: Cyclosporine, Ciclosporin Trade Name: Neoral, Gengraf Company Name: Novartis Pharmaceuticals Corporation Date of approval: 1997 [ref] MOA: Cyclosporine acts as a P-glycoprotein inhibitor, a calcineurin inhibitor, and a cytochrome P450 3A4 inhibitor. Cyclosporin A (CsA) prevents the production of interleukins (IL), notably IL-2, which is necessary for the self-activation and differentiation of T lymphocytes (LT). Uses: It is used for the therapy of psoriatic arthritis and other autoimmune and inflammatory diseases, including rheumatoid arthritis and lupus. Major contraindications:
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Leflunomide for Psoriatic Arthritis: |
| Generic Name: Leflunomide Trade Name: Arava Company Name: Lupin LTD Date of approval: September 10, 1998 MOA: Leflunomide’s active metabolite, A771726, has the ability to inhibit the human enzyme dihydroorotate dehydrogenase (DHODH) and has antiproliferative properties. Uses: Leflunomide and methotrexate work well together to lessen psoriatic arthritis patients’ skin involvement and joint discomfort. Major contraindications:
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Apremilast for Psoriatic Arthritis: |
| Generic Name: Apremilast Trade Name: Otezla Company Name: Amgen Inc Date of approval: March 21, 2014 [ref] MOA: Apremilast is an orally accessible targeted PDE4 inhibitor that affects a wide range of inflammatory mediators involved in psoriatic arthritis, including decreases in inducible nitric oxide synthase, TNF-α, and interleukin (IL)-23 production and increases in IL-10. Uses: Active psoriatic arthritis is treated with apremilast. Major contraindications:Hypersensitivity to apremilast or any of the formulation’s excipients. |
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TNF Inhibitors indicated for the treatment of Psoriatic Arthritis:
TNF inhibitors are being increasingly used for the treatment of psoriatic arthritis. They are more potent and safer than conventional DMARDs.
Etanercept for Psoriatic Arthritis: |
| Generic Name: Etanercept Trade Name: Enbrel, Erelzi Company Name: Sandoz, Switzerland Date of approval: January 2002 [ref] MOA: Etanercept is a biological tumor necrosis factor (TNF) inhibitor. TNF is a cytokine that is involved in inflammation and the immune response and can connect to TNF receptor 1 (TNFR1) or TNF receptor 2 (TNFR2). Etanercept acts by inhibiting TNF-alpha, a pro-inflammatory cytokine that is increased in psoriasis, psoriatic arthritis, and rheumatoid arthritis. Uses: Etanercept injections are used to treat the signs and symptoms of psoriatic, rheumatoid, and active arthritis, such as joint pain, edema, exhaustion, and the length of morning stiffness. Major contraindications:
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Infliximab for Psoriatic Arthritis: |
| Generic Name: Infizimab Trade Name: Inflectra, Remicade, Renflexis Company Name: Pfizer Laboratories LTD. Date of approval: May 2005 [ref] MOA: Infliximab suppresses TNF-α activity via binding to the transmembrane and soluble forms of the protein, as well as inhibiting TNF-α from interacting with its receptor. TNF-α’s biological actions include the induction of inflammatory cytokines such as interleukin-1 (IL-1) and IL-6, the facilitation of leukocyte migration, the induction of eosinophil and neutrophil activity, and the stimulation of acute-phase reactants and tissue-degrading enzymes. Uses: Infliximab is used to improve physical function, slow the development of structural damage, and lessen the signs and symptoms of active arthritis in psoriatic arthritis patients. Major contraindications:
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Adalimumab for Psoriatic Arthritis: |
| Generic Name: Adalimumab Trade Name: Amjevita, Cyltezo, Humira, Hadlima, Hyrimoz, Adalimumab-atto, Adalimumab-adbm, Adalimumab-bwwd, Adalimumab-adaz Company Name: AbbVie Inc. Date of approval: October 2005[ef] MOA: Adalimumab is a Recombinant human anti-TNF-α IgG1 monoclonal antibody; blocks TNF-α’s ability to cause inflammation; it binds to TNF-α selectivity and prevents it from interacting with the p55 and p75 cell surface TNF receptors; lyses surface TNF-expressing cells in vitro; and modifies the biological processes that control leukocyte migration. Uses: Adalimumab is a medication used to treat the pain and swelling caused by some kinds of arthritis (such as psoriatic, juvenile idiopathic, and ankylosing spondylitis). Major contraindications: None |
Golimumab for Psoriatic Arthritis: |
| Generic Name: Golimumab Trade Name: Simponi, Simponi Aria Company Name: Janssen Biotech, Inc. Date of approval: April 2009 [ref] MOA: Human anti-TNF-alpha monoclonal antibody binds to both soluble and transmembrane bioactive forms of human TNFα; blocks TNF-alpha binding to its receptors, hence inhibiting TNF biological activity (a cytokine protein). Uses: Golimumab is used to treat the symptoms of a number of active inflammatory illnesses, including psoriatic arthritis, rheumatoid arthritis, ankylosing spondylitis, and ulcerative colitis. Major contraindications: None |
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Certolizumab pegol for Psoriatic Arthritis: |
| Generic Name: Certolizumab pegol Trade Name: Cimzia Company Name: UCB Group of Companies Date of approval: September 27, 2013 [ref] MOA: Certolizumab pegol binds to both soluble and membrane-bound TNF-α, reducing the cytokine’s proinflammatory activities. In contrast to other TNFi, it is unable to fix complement or bind to Fc receptors because it lacks the Fc component. Uses: Psoriatic arthritis is another condition for which Certolizumab is occasionally used. Major contraindications:
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Interleukin Inhibitors for the treatment of Psoriatic Arthritis:
Interleukin inhibitors are among the newly approved medications approved by the FDA for the treatment of psoriatic arthritis.
Different Interleukin inhibitors affect different pathways.
Ustekinumab for Psoriatic Arthritis: |
| Generic Name: Ustekinumab Trade Name: Stelara Company Name: Janssen Pharmaceuticals Date of approval: September 24, 2013 [ref] MOA: Human IgG1κ monoclonal antibody binds to the p40 protein subunit used by the cytokines IL-12 and IL-23; IL-12 and IL-23 are implicated in inflammatory and immunological responses (for example, natural killer cell activation, CD4+ T-cell differentiation, and activation). Uses: Psoriatic arthritis is treated with this drug. Major contraindications:
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Guselkumab for Psoriatic Arthritis: |
| Generic Name: Guselkumab Trade Name: Tremfya Company Name: Janssen Global Services, LLC. Date of approval: July 2020 [ref] MOA: Guselkumab is a monoclonal antibody (IgG1-lambda) that suppresses IL-23 by specifically binding to its p19 subunit; IL-23 is a natural cytokine linked with inflammatory and immunological responses; guselkumab inhibits IL-23’s pro-inflammatory activities, hence lowering cytokine and chemokine release. Uses: It is used for the treatment of adult patients with active psoriatic patients. Major contraindications:History of severe hypersensitivity to guselkumab or any of the excipients. |
Ixekizumab for Psoriatic Arthritis: |
| Generic Name: Lxekizumab Trade Name: Taltz Company Name: Eli Lilly and Company Date of approval: March 22, 2016 MOA: Ixekizumab is a humanized monoclonal IgG4 antibody that targets and neutralizes the proinflammatory effects of interleukin-17A (IL-17A). IL-17A is a naturally present cytokine that is essential for healthy immunological and inflammatory responses and plays a significant role in the development of plaque psoriasis. Uses: Psoriatic arthritis is another condition for which Abatacept is occasionally used. Major contraindications:Hypersensitivity reaction ( e.g., anaphylaxis) to the medicine or excipients. |
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Secukinumab for Psoriatic Arthritis: |
| Generic Name: Secukinumab Trade Name: Cosentyx Company Name: Novartis Pharmaceuticals UK Ltd. Date of approval: January 2016 [ref] MOA: Secukinumab binds to and inhibits IL-17A3, preventing it from interacting with the IL-17 receptor and activating the IL-17 receptor signaling pathway, which is linked to inflammatory processes. Uses: Secukinumab is used to treat psoriatic arthritis alone or in conjunction with methotrexate. Major contraindications:Hypersensitivity Reactions |
Selective co-stimulation modulators for Psoriatic Arthritis:
Abatacept (Orencia) is the pioneer drug in this category and one of the safest medications for the treatment of psoriatic arthritis.
Abatacept for Psoriatic Arthritis: |
| Generic Name: Abatacept Trade Name: Orencia, Orencia ClickJect Company Name: Bristol-Myers Squibb Company Date of approval: July 2017 [ref] MOA: Abatacept is a selective costimulation modulator that, has been demonstrated to decrease T-cell activation by binding to CD80 and CD86, thereby preventing interaction with CD28. This interaction has been found to hinder the delivery of the second co-stimulatory signal essential for effective T-cell activation. Uses: Psoriatic arthritis is another condition for which Abatacept is occasionally used. Major contraindications: None |
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JAK-STAT inhibitors for the treatment of Psoriatic Arthritis:
Tofacitinib is an oral JAK-STAT inhibitor indicated for the treatment of psoriatic arthritis, apart from its use in Rheumatoid arthritis and IBDs.
Tofacitinib for Psoriatic Arthritis: |
| Generic Name: Tofacitinib Trade Name: Xeljanz, Xeljanz XR Company Name: Pfizer Inc. Date of approval: 2017 [ref] MOA: Tofacitinib is a partial and reversible JAK inhibitor that prevents the body from reacting to cytokine signals. Tofacitinib suppresses the phosphorylation and activation of STATs by inhibiting JAKs. The JAK-STAT signaling pathway is involved in the transcription of cells engaged in hematopoiesis and immune cell activity. Tofacitinib reduces inflammation by blocking the JAK-STAT pathway. Uses: Tofacitinib is used alone or with other medications to treat psoriatic arthritis, rheumatoid arthritis, ulcerative colitis, and pcJIA. Major contraindications: None |
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