She Strengthens

Understanding Biologics for Psoriatic Arthritis

Psoriatic arthritis (PsA) is a painful condition that affects not only the skin and joints but also energy levels, significantly impacting quality of life. Fortunately, biologic therapies have proven to be highly effective in managing PsA. However, finding the right regimen can take time. Dr. Stella Bard, a board-certified rheumatologist, sheds light on how biologics work and what to expect from treatment.

What Are Biologics?

Biologics are immune treatments administered through injection or infusion. They contain proteins that target specific cytokines or proteins in the blood and immune system involved in inflammation. These treatments are derived from animal or human sources, while synthetic biologics are created in a lab.

Types of Biologics for PsA

Biologic treatments for PsA include:

• TNF inhibitors: adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), golimumab (Simponi), and infliximab (Remicade)
• IL-17 inhibitors: ixekizumab (Taltz) and secukinumab (Cosentyx)
• IL-23 inhibitors: guselkumab (Tremfya) and risankizumab (Skyrizi)
• IL 12/23 inhibitors: ustekinumab (Stelara)

Delivery Methods

Biologics can be administered through:

• Self-injectable pens with auto-injectors
• Pre-filled syringes with manual injection
• Infusions in a hospital or clinic setting, or at home

Risks and Side Effects

While biologics are effective, they do come with some risks and side effects. These include:

• Increased risk of common infections, such as upper respiratory infections, pneumonia, and urinary tract infections
• Injection site reactions, including redness, itching, swelling, and pain
• Infusion reactions, which may cause flushing, nausea, rash, and shortness of breath
• Reactivation of infections like tuberculosis or hepatitis B
• Rare cases of lupus-like syndrome, congestive heart failure, and liver problems
• Slightly increased risk of certain cancers and demyelinating disorders

Taking Biologic Medications

Biologics are injected into the skin or infused into a vein. The specific dosage depends on the disease, and different regimens are used for the same drug. For example, adalimumab (Humira) is prescribed as one injection every 2 weeks for PsA, while certolizumab pegol (Cimzia) requires a loading dose every 2 weeks, three times in the first month, followed by monthly maintenance doses.

Using Auto-Pens and Pre-Filled Syringes

Each medication comes with detailed instructions and videos on how to use. In general, the steps involve:

• Removing the auto-pen or syringe from the fridge and preparing the injection site
• Cleaning the injection site with an alcohol swab
• Injecting the medication and holding for a few seconds
• Disposing of the pen or syringe in a safe container

Combining Biologics with Other Medications

Biologics can be taken in combination with synthetic DMARDs, such as methotrexate, leflunomide, and otezla (a PDE4 inhibitor). Certain biologics, like IL-23 and IL-17s, can be used with targeted small molecules, such as Janus Kinase inhibitors, while monitoring for immunosuppression. NSAIDs and steroids can be used for symptom relief until the biologic takes effect or during flares.

Dr. Stella Bard is a board-certified rheumatologist with over 13 years of experience in managing complex medical problems. She is dedicated to helping patients living with rheumatologic conditions, especially in diverse communities.