What Else Do I Need To Know About Biologics For Psoriatic Arthritis
Biologics are effective, but they increase your risk of infection, Ostrowski says.
If you develop an active infection while taking one of these drugs, you may need to stop treatment until you recover. Similarly, if you have active tuberculosis, hepatitis, or the human immunodeficiency virus , you will need to get the condition under control before starting biologic treatment.
If youve recently had cancer, you should discuss this with your rheumatologist and your oncologist before considering biologic treatment, Ostrowski advises.
Stay away from unpasteurized milk, raw meat, and raw eggs while taking these drugs to avoid catching a food-borne illness.
Also, women with psoriatic arthritis who are considering pregnancy and breastfeeding have additional things to consider. Many DMARDs, including biologics, cannot be used if youre pregnant or breastfeeding, Ostrowski says. If you may become pregnant, you need to discuss taking a biologic drug with your doctor first.
Causes Of Psoriatic Arthritis
Researchers arent entirely sure what causes psoriatic arthritis but speculate genetics are involved. One theory is that psoriatic arthritis is connected to a family of genes called the human leukocyte antigen complex, which helps the immune system differentiate between proteins that are from the body, and those that are made by bacteria, viruses, and other pathogens. Some experts believe that trauma from an injury may trigger psoriatic arthritis in people who are already prone to the condition. Although anyone can develop psoriatic arthritis, its most common in people between 30 and 50 years old.
To be clear, psoriasis doesnt cause psoriatic arthritis. However, having psoriasis is the single largest risk factor for developing psoriatic arthritis. In particular, people who have nail psoriasis symptoms4 have a higher risk of developing psoriatic arthritis.
Your Symptoms Make Your Job Or Daily Life Hard
This can mean different things for different people.
If you’re a college professor and your treatment gets rid of all your symptoms except two swollen finger joints, you might be OK with that. But if you’re a concert violinist who relies on those joints for a living, those same symptoms could be a show-stopper.
Tell your doctor what you need to keep up with your day-to-day activities.
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What Do I Need To Know About Methotrexate For Psoriatic Arthritis
Methotrexate is a DMARD because it reduces pain and swelling and may prevent joint damage and disability. It works by blocking inflammation caused by your immune system. It’s often started at a weekly dose, and it may take up to six weeks to provide results, Ostrowski says.
Side effects of methotrexate can include hair loss and mouth ulcers. It can also cause inflammation of the liver, so liver function tests need to be done, according to the NPF. Also, you shouldnt drink alcohol while taking methotrexate. Taking the B vitamin folic acid may help prevent some of these side effects, Ostrowski says.
Fertility Pregnancy And Breastfeeding
Women using this drug should use contraception or encourage their partner to. Talk to your doctor as soon as possible if youre planning to start a family.
You shouldn’t take methotrexate if you’re pregnant or trying for a baby, as it can affect how an unborn baby develops.
Methotrexate should be stopped three months before you become pregnant. If you become pregnant while taking methotrexate or if you’ve had less than a three-month break from the drug, it’s important to speak to your doctor as soon as possible.
It used to be recommended that men stop methotrexate three months before trying for a baby, but research now shows it’s fine for men to continue taking methotrexate when trying for a baby with their partner.
If you are planning to try for a baby it’s important to take folic acid to support the health of you and your baby.
You shouldnt breastfeed if youre on methotrexate, as the drug could pass into breast milk, and we yet dont know what effects this could have on a baby.
Your doctors will usually recommend going straight back onto methotrexate once youve finished breastfeeding. This is because the sooner you can get back onto your medication, the lower the risk of having a flare.
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Ra And Methotrexate: Does Methotrexate Reduce Inflammation
If you have rheumatoid arthritis , youre probably very familiar with the pain and joint swelling that this particular type of arthritis can cause. If youve had it for some time, you may even be experiencing the joint deformities that can occur as RA progresses. As you know, any joint deformity can take a significant toll on your joint function as well as your overall quality of life.
RA usually attacks the joints of the hands and feet first, which means even simple activities like tying a shoe, brushing your teeth, combing your hair, or getting dressed in the morning can become painful enterprises. Leisurely pursuits like gardening or taking long walks may have lost their appeal as well, largely as a result of the pain and inflammation these joint-based movements can trigger.
Although there is currently no cure for RA, there are medications that a doctor can prescribe to slow the progression of joint destruction and deterioration. One of the most popular and also most effective of these is a folate analog called methotrexate . Its a treatment option with one of the longest and most well-established safety profiles of any rheumatoid arthritis drug on the market.
Psa Patients Want Their Medication To Improve Joint Pain Symptoms
The study included other evidence to support the theory that pain-related symptoms are more bothersome for PsA patients than other symptoms.
As part of the survey, participants were asked to choose between five hypothetical medicines that traded off different levels of improvement in skin and joint symptoms. Most patients chose a medicine with either significant or complete improvement in joint symptoms and mild or no improvement in skin symptoms, while 21 percent chose a medicine that provided moderate improvement in both joint and skin symptoms. This further suggests that pain-related symptoms are the most bothersome and have the greatest impact on patients daily lives compared to non-pain-related symptoms, like nail pitting, skin plaques, and swollen fingers.
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Is There A Risk If The Father Is On Methotrexate
For many years men were advised not to father children while they were on methotrexate and for at least 3 months afterwards because methotrexate had been reported to cause a reduction in sperm count. The current expert view is that the risks are very low, and this precautionary approach is not necessary.
Safety Measures On Methotrexate
Methotrexate should be kept out of the reach of children. Do not give this medication to other people. Dispose of the injected form of methotrexate in appropriate sharps containers.
Close monitoring, ie medical supervision of patients on methotrexate is essential. It is important that you carry out your doctor’s instructions faithfully and promptly report any side effects or symptoms you may develop.
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Perspectives And Place In Therapy
PsA is increasingly recognized as an important condition that can cause persistent inflammation, progressive joint damage, disability, and impaired quality of life. Previously, treatments for PsA included NSAIDs, steroids, and some synthetic DMARDs. The treatment paradigms were largely borrowed from treatment of peripheral arthritis in RA.
The situation changed dramatically with the introduction of biologic agents, particularly TNFi. The notable clinical efficacy of TNFi has resulted in significant advances in the treatment of PsA. Of note, TNFi were effective across the various domains of TNFi. This generated interest in defining outcomes in these varied aspects of PsA, including skin and nail disease, enthesitis, axial arthritis, and dactylitis. In addition, the success of TNFi in improving signs and symptoms of PsA has raised the goals of therapy. Much different than in years past, when any improvement was considered a success, current treatment aims at achieving the lowest level of disease activity possible for each patient in each aspect of disease. In addition to signs and symptoms of disease, optimizing quality of life, preserving functional status and minimizing joint damage are considered goals of treatment.
What About Side Effects
Methotrexate can cause mouth ulcers in a few patients, in the beginning of treatment. This should go away with time. Another possible side effect is nausea and vomiting. Methotrexate can also cause hair thinning or hair loss. In rare cases some people may develop lung problems.
Methotrexate can cause mild liver irritation. Please tell your doctor if you have a history of any alcohol abuse, hepatitis, yellow jaundice, or liver disease. While on methotrexate you should limit yourself to 2 alcoholic beverages per week. Blood work will be done every 4-12 weeks to check your liver function. This blood work will also include a complete blood count since methotrexate can also cause a decrease in blood counts. This blood work is very important. It allows the rheumatologist to make timely changes to your dose of methotrexate if there is ever problem.
Methotrexate is known to cause birth defects in the children of both men and women taking this drug. If you are pregnant considering having a child, or nursing, discuss this with your rheumatologist before beginning this medication. You must use an effective form of birth control while taking methotrexate and for at least 3 months after the methotrexate is stopped. Your rheumatologist or nurse can give you additional guidance.
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Side Effects Bother You
Many meds that treat psoriatic arthritis make a big difference, but they all have risks.
For instance, NSAIDs can make stomach irritation and bleeding more likely. Methotrexate, which is prescribed for many types of arthritis, can damage the liver. And because medicines called biologics work on your immune system, they can make serious infections more likely.
Let your doctor know if you have side effects from your medication.
Side Effects Of Methotrexate
Side effects can occur at any time during treatment with methotrexate but are most common in the first few weeks. Folic acid supplements may be prescribed, as they are thought to reduce some of the side effects of methotrexate. There is still some debate as to the best dose and timing of folic acid. The current expert recommendation is to take 5 mg once a week, eg on a Friday .
If the side effects described below or other problems trouble you, or should you develop any signs of infection or unusual bleeding, notify your doctor promptly and before your next dose of methotrexate is due.
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Psoriatic Arthritis Treatment For Feet
There is no cure for psoriatic arthritis but there are medications that help control inflammation and pain. Each of these psoriatic arthritis treatments work differently, and your doctor will make a recommendation based on your particular situation.
Some of the most commonly prescribed medications include:
- Nonsteroidal anti-inflammatory drugs are available over the counter and by prescription to help ease pain and inflammation. These do not prevent psoriatic arthritis from progressing.
- Disease-modifying antirheumatic drugs are available only by prescription. These drugs can prevent psoriatic arthritis from worsening and preserve joint tissue.
- Immunosuppressants target your immune system to prevent it from attacking healthy tissue.
- Biologics are a new form of DMARDs that target the specific part of the immune system triggering inflammation. Sometimes biologics are used in conjunction with another DMARD.
Doctors may also administer corticosteroid injections into the affected foot joints to help with pain, according to Gottlieb.
Psa Patients Prefer Medication In The Form Of An Oral Pill Taken Once A Day
The treatment plan portion of the survey allowed people to share how and how often they prefer to receive PsA treatment. Patients were asked to rank four different ways of taking their psoriatic arthritis medication oral tablet once a day, oral tablet twice a day, an injection every two weeks, or an injection once a month from most preferred to least preferred. When it came to their first-choice treatment:
- 38% said oral tablet once a day
- Less than 1% said oral tablet twice a day
- Less than 1% said oral tablet twice a day
- 25% said injection once a month
- 26% said they had no preference
Convenience and ease were the main factors in patients preferred treatment choice. The top three reasons patients listed for choosing a one-a-day oral treatment were: its fast and easy to take its easier to travel with and its easier to remember
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Myth: Methotrexate Can Cure Your Ra
At this time, theres no cure for RA. Methotrexate is the first line of treatment for most people with active disease, and it can help you get your inflammation under control so you feel much better. Your treatment goal is to get your RA into remission, but thats not the same as a cure. Methotrexate can help you lower your disease activity measured with various tests your rheumatologist will give you but it doesnt technically cure your RA.
Heres How Humira Works:
- When you have psoriatic arthritis, your body overproduces inflammation-causing proteins, including one called tumor necrosis factor-alpha
- This inflammation can cause the joint pain and swelling and the red, scaly patches, called plaques, that you are experiencing
- HUMIRA targets and blocks TNF-alpha, which is a specific source of inflammation
- Because TNF blockers, including HUMIRA, affect the immune system, they can lower the ability to fight infections and may cause other serious side effects
Did you know that some patients using HUMIRA saw improvement in joint pain and skin symptoms in as soon as 2 weeks?*
See how others responded.
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Doses For Inflammatory Conditions
For inflammatory conditions such as psoriasis, rheumatoid arthritis and Crohn’s disease, the dose will vary. This depends on your condition and blood test results. Always follow the instructions from your doctor.
For rheumatoid arthritis, the usual starting dose is 7.5mg, taken once a week. This can be slowly increased up to 20mg or 25mg once a week.
For psoriasis, the usual starting dose is 2.5mg to 10mg, taken once a week. It can be slowly increased up to 30mg once a week.
For Crohn’s disease, the usual dose to prevent flare-ups is 10mg to 25mg, taken once a week. This is often called a “maintenance” dose.
If your child is prescribed methotrexate, the doctor will use their height and weight to work out the right dose.
What If Methotrexate Isnt Working For My Psoriatic Arthritis
If methotrexate doesnt work for you or if youre having side effects, your doctor may try prescribing another DMARD or a biologic therapy, according to the NPF. The dose of methotrexate may be increased over two to three months if its tolerated but not effective at a lower dose, Ostrowski says. If that doesnt work, other options would be to try another traditional DMARD or switch to a newer biologic DMARD, such as a TNF inhibitor.
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Myth: You Should Stop Non
The scary things you may read about the dangers of combining NSAIDs and methotrexate are primarily aimed at people taking high-dose methotrexate to treat cancer. Methotrexate is eliminated from the body by the kidneys, and if your kidney function is impaired , then methotrexate levels may increase to dangerous amounts resulting in severe consequences such as bone marrow and liver damage, says Bryant England, MD, assistant professor in the division of rheumatology and immunology at the University of Nebraska Medical Center in Omaha.
On low-dose methotrexate you wont be forbidden from using NSAIDs. However, regular blood work to monitor for these complications is essential while on methotrexate and may need to be more frequent when NSAIDs are also used, says Dr. England.
You may also find that you dont need NSAIDs as much as you used to before you started methotrexate. Patients and providers should regularly evaluate whether there is an ongoing need for NSAIDs or if alternative medications or non-drug therapies for pain relief could be substituted, Dr. England says.
What About Other Medications
When you are taking methotrexate, it is very important that your doctors know if you are taking any other medicine. This includes prescription and non-prescription medicines as well as birth control pills, vitamins, and herbal supplements. Methotrexate can be taken with other medications. You should not take methotrexate while taking antibiotics containing trimethoprim-sulfa . If you are prescribed one of these medications for an infection, do not take your methotrexate that week.
How And When Is Methotrexate Taken
Methotrexate can be taken as a tablet, liquid or injection.
Methotrexate should be taken on the same day once a week. Youll be given a starting dose of methotrexate while your rheumatologist tries to bring your condition under control, but this might be increased if it isnt helping your symptoms.
Methotrexate tablets come in two strengths: 2.5 mg and 10 mg. To avoid confusion, its recommended you only be given one strength, usually 2.5mg. If you are prescribed both tablet strengths be very careful not to confuse them, as they can look quite similar.
If you are starting methotrexate injections, you’ll usually be given your methotrexate injection by a health professional. They will often show you how to inject yourself using either a syringe or injector pen, so you can do it at home. Let them know if you think you will have difficulty injecting yourself.
You must always wash your hands before and after handling methotrexate.
Surprise Mtx Proves Effective In Psoriatic Arthritis
REPORTING FROM RWCS 2019
MAUI, HAWAII The first-ever, double-blind, randomized, controlled clinical trial evidence demonstrating that methotrexate indeed has therapeutic efficacy in psoriatic arthritis has come at an awkward time on the heels of a basically negative Cochrane Collaboration systematic review as well as the latest American College of Rheumatology/National Psoriasis Foundation guidelines for treatment of psoriatic arthritis, which recommend antitumor necrosis factor therapy as first line, ahead of methotrexate.
The timing of the release of the SEAM-PsA randomized trial results was such that neither the Cochrane group nor the ACR/NPF guideline committee was able to consider the new, potentially game-changing study findings.
I look at SEAM-PsA and have to say, methotrexate does seem to be an effective therapy. I think it calls into question the new guidelines, which were developed before the data were out. Now you look at this and have to ask, can you really say you should use a TNF inhibitor before methotrexate based on these results? I dont know, Eric M. Ruderman, MD, said at the 2019 Rheumatology Winter Clinical Symposium.
He also shared other problems he has with the new guidelines, which he considers seriously flawed.