If conventional treatments aren’t keeping your psoriatic arthritis (PsA) under control — or if you have extensive irreversible joint damage — your doctor may prescribe a type of medication called biologics. A type of disease-modifying antirheumatic drug (DMARD), biologics work by targeting specific cells or proteins of your immune system that cause inflammation associated with PsA symptoms.

If you have PsA, your doctor may talk to you about whether biologics are a good fit for your treatment plan. Members of MyPsoriasisTeam sometimes discuss these types of medications.

“I’m researching all biologics to see what helps with psoriatic arthritis pain,” one member wrote. Another said, “I benefited from a biologic.”

Here are seven things to know about using biologics for PsA.

1. Prepare Before Starting a Biologic

Biologic drugs work by suppressing your immune system. While this helps to tamp down inflammation, it also decreases your ability to fight off infections. Before you start taking one of these medications, you should take steps to make sure you stay healthy.

Before prescribing a biologic, your doctor will screen you for certain infections. You should let your care team know if you currently have an infection or if you’ve recently visited areas where fungal infections are common, such as in the Southwestern United States.

In addition, don’t start a biologic if you’re sick. Your doctor will test your blood for tuberculosis and hepatitis B infections. If you have them, they must be treated before you can start biologic therapy.

To prevent infections while you’re taking a biologic, make sure you’re up to date on all of your vaccines before you start using the medication. This is important because while you’re using a biologic, you can’t get a live vaccine, such as the chicken pox or measles vaccine. The Centers for Disease Control and Prevention (CDC) also recommends the following vaccines for anyone who is planning to be treated with immunosuppressive drugs:

• Pneumococcal vaccines
• Meningococcal vaccines
• Haemophilus influenzae (Hib) vaccine
• Zoster (shingles) vaccine

2. Biologics Are Made of Antibodies

Biologics are made of monoclonal antibodies created in a laboratory to act like proteins called antibodies. These types of antibodies are developed to aim at a specific target in the immune system.

In autoimmune diseases like PsA, the immune system mistakenly targets the joints and attacks them the same way it would go after a foreign invader like bacteria. This causes damage and psoriatic arthritis symptoms in your joints and skin. Biologic treatments work by interrupting different parts of the inflammation cycle to stop the damage.

Following are a few biologic types that your doctor may prescribe for PsA.

TNF-Alpha Inhibitors

Tumor necrosis factor-alpha (TNF-alpha) inhibitors block the TNF-alpha protein. People with PsA have excess TNF-alpha production in their joints. TNF-alpha plays a central role in inflammation by activating B cells and T cells and making cytokines (proteins that encourage inflammation). Monoclonal antibodies that target TNF-alpha can help to stop the inflammation process.

TNF-alpha inhibitors are recommended as a first-line treatment by the American College of Rheumatology and the National Psoriasis Foundation guidelines for psoriatic arthritis.

Biologics approved by the U.S. Food and Drug Administration (FDA) to treat PsA include:

• Adalimumab (Humira)
• Certolizumab pegol (Cimzia)
• Etanercept (Enbrel)
• Golimumab (Simponi)
• Infliximab (Remicade)

Interleukin Inhibitors

Interleukin (IL) inhibitors have antibodies that target different types of interleukins. Interleukins are a type of cytokine that activate white blood cells (WBCs), causing inflammation. The interleukin inhibitors currently available target either IL-12, IL-23, or IL-17.

FDA-approved IL-23 inhibitors include:

• Guselkumab (Tremfya)
• Risankizumab (Skyrizi)
• Ustekinumab (Stelara) — Inhibits both IL-12 and IL-23

FDA-approved IL-17 inhibitors include:

• Ixekizumab (Taltz)
• Secukinumab (Cosentyx)

T-Cell Inhibitors

T-cell inhibitors decrease inflammation by blocking overactive T cells that can damage the tissue in your joints. T cells are a type of WBC that can cause inflammation in PsA.

Abatacept (Orencia) is currently the only drug in this category that is FDA approved to treat PsA.

3. Biologics Are Administered by Infusion or Injection

Biologics are not available in a form that can be swallowed, like a pill. The monoclonal antibodies would be destroyed in your stomach if you took these medications by mouth. Instead, they must be infused into a vein or injected subcutaneously (under the skin).

Infusions are usually given at a health care facility by a nurse. If you are prescribed a subcutaneous injection, you can give it to yourself at home in most instances. They are usually given in the stomach or thigh. Your doctor or pharmacist will teach you how to use your medication.

How often you take a biologic varies from twice weekly to once every three weeks, depending on the specific drug.

4. It Can Take Time To Feel the Effects of Biologics

Biologics can be a life-changing treatment to control joint pain, stiffness, and swelling caused by PsA. However, biologics should not be considered a quick fix — it can take up to three months before you start to feel an improvement.

Many biologics can be used with other PsA treatments, such as nonsteroidal anti-inflammatory drugs (NSAIDs), to control pain until the biologic has time to take effect. Talk to your doctor about your treatment options for pain when starting a biologic.

However, if you find you still need to take pain medications frequently after three months, it may be a sign the biologic isn’t working for you or that there’s a secondary cause for your pain.

These medications tend to work best if you take them continuously. If you stop and start biologics, they may not work as well and you may experience side effects.

5. Biologics Are Safe, but Side Effects Are Possible

In clinical trials, biologics have been shown to be safe and tolerable for most people. An analysis evaluating the safety and efficacy of biologics in PsA found that the likelihood of side effects was about the same for all biologics.

All medications have possible side effects. For most people, they’re not serious enough to stop the medication. The most common side effects with biologics include:

• Injection site reactions
• Flu-like symptoms
• Respiratory infection
• Fatigue
• Nausea
• Headache

Although serious side effects are rare, you should be aware of the following when taking biologics:

• Infections — One side effect of targeting the immune system to calm down inflammation is that you have an increased risk of infections.
• Allergic reactions — With any medications, you face the risk of serious allergic reactions or anaphylaxis (a potentially life-threatening allergic reaction).
• Cancer — Long-term use of biologics may increase the risk of certain cancers, including skin cancer and lymphoma.
• Worsening heart conditions — Some biologics can make preexisting heart conditions worse, such as heart failure.

The possible side effects of biologics can be intimidating, so it’s important to weigh the benefits and risks. Uncontrolled inflammation in PsA can have serious consequences as well, including disability and effects on your quality of life.

One MyPsoriasisTeam member said, “I started using biologics because I was more afraid of what would happen to my body if I didn’t control the damage. We all make the call for ourselves.”

Talk to your health care provider about the possible side effects of your medication so you can decide whether it’s right for you.

6. Biologics Might Become Less Effective Over Time

It is possible for a biologic to stop working after you have been taking it for a while. One MyPsoriasisTeam member said, “Biologics work great for me until they don’t.”

Your body can overcome a biologic if your immune system develops antibodies to the proteins in the medication. When this happens, it can counteract the effect of the biologic. You should also be aware that it is possible for your symptoms to flare up while using a biologic. A MyPsoriaisTeam member shared, “Even with the biologic working, I can still flare.”

If one biologic stops working, your doctor may recommend switching to a different one. They’ll take into account the frequency and severity of your flare-ups when considering whether to recommend a different medication.

7. Biologics Can Be Expensive

The cost of treatment is a major concern for people using biologics. On average, biologics cost between $10,000 and $30,000 per year without insurance.

Although biologics are expensive, you shouldn’t have to pay for them alone — most insurance plans will cover these drugs. If you are prescribed a biologic, call your insurance plan directly to ask whether it’s covered and what your out-of-pocket costs might be.

Biosimilar medications may be less expensive than the original branded medication. These are medications that are modeled after a brand name that is already in use. The FDA approval process for biosimilars ensures that the biosimilar medication is as safe and effective as the medication it’s modeled after.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis and their loved ones. On MyPsoriasisTeam, more than 115,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriatic arthritis.

Are you taking a biologic drug for PsA? Share your experience in the comments below, or start a conversation by posting on your Activities page.