What You Need to Know About Immunosuppressants for Psoriatic Arthritis
These drugs can help prevent permanent joint damage. Find out how they work and if they might be a treatment option for you.
By Krisha McCoy
Medically Reviewed by Sanjai Sinha, MD
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If you have psoriatic arthritis, there are several treatment options available for managing the condition. One of these is a class of drugs known as immunosuppressants, which work by suppressing the immune system.
Unlike non-steroidal anti-inflammatory drugs (NSAIDs), which primarily help relieve the pain, swelling, and stiffness associated with psoriatic arthritis, immunosuppressant drugs may actually help prevent permanent joint damage. These work by blocking the activity of your immune system, which can slow the growth of certain types of cells.
Types of Immunosuppressants
Commonly prescribed immunosuppressant drugs for psoriatic arthritis include:
Methotrexate (Rheumatrex, Trexall) "Methotrexate is helpful for both psoriasis and the arthritis associated with psoriasis," says Evan Siegel, MD, rheumatologist with Arthritis and Rheumatism Associates in Rockville and Wheaton, Maryland, and assistant clinical professor of medicine at Georgetown University School of Medicine in Washington, DC. Methotrexate is taken once a week, either orally or by injection.
While there's not a lot of clinical trial data supporting the use of methotrexate to treat psoriatic arthritis, Dr. Siegel says that it has been successfully used for more than 30 years in clinical practice. It's also the most commonly prescribed drug for treating rheumatoid arthritis.
About half of people who have psoriatic arthritis respond to methotrexate, according to Lenore Buckley, MD, MPH, rheumatologist and professor of medicine at Yale School of Medicine in New Haven, Connecticut.
Arava (leflunomide) If you can't tolerate methotrexate or can't take it for other health reasons, your doctor may try the immunosuppressant medication leflunomide. "It has been moderately helpful for the joints in clinical trials," says Siegel. He adds that about 40 percent of people with psoriatic arthritis who take leflunomide will have improvement in their joints.
Cyclosporine Approved by the Food and Drug Administration (FDA) for treating psoriasis, cyclosporine may also help relieve some psoriatic arthritis symptoms. “But the studies are small, and it’s not FDA-approved for the treatment of psoriatic arthritis,” says Dr. Buckley. She points out that it's usually used as an add-on therapy with other medication to get additional benefits.
What About Side Effects?
“Immunosuppressive drugs act to decrease the activity of the immune system, but in a nonspecific way,” says Audrey Uknis, MD, rheumatologist and professor at the Lewis Katz School of Medicine at Temple University in Philadelphia. Dr. Uknis says that these drugs can potentially lead to unwanted side effects because they target the immune system.
When methotrexate is used in small doses, as it usually is to treat psoriatic arthritis, it's generally tolerated well. Common side effects include nausea and mouth sores, and use of the drug raises the risk of liver damage.
The most common adverse reaction to leflunomide is diarrhea. Other potential side effects include hair loss, upset stomach, and liver problems.
Side effects of cyclosporine include kidney damage, high blood pressure, and high cholesterol. Your doctor will give you regular blood tests to check your kidney function while taking cyclosporine.
When Immunosuppressants Aren't the Right Choice
Since immunosuppressant drugs suppress your immune system, you should not take them if you have a compromised immune system — from lymphoma or HIV, for example — or a serious and active infectious disease.
Due to the potential for liver damage when taking methotrexate, people who suffer from alcoholism or have impaired liver function, such as those with cirrhosis or hepatitis, should not take methotrexate. Pregnant women, women who are nursing, and women (and their male partners) who are planning to become pregnant shouldn’t take this medication, either.
People with active peptic ulcers, kidney abnormalities, and pre-existing blood problems should also avoid methotrexate.
RELATED LINK: 5 Desserts for Psoriatic Arthritis Pain
People who have impaired liver function or alcoholism should not take leflunomide. Since it can cause serious birth defects, women who are pregnant should avoid taking it, too. And as it can take years for leflunomide to get out of your system, both men and women who are planning to have a child should talk to their doctors first.
People who have abnormal kidney function, uncontrollable high blood pressure, a history of cancer, or severe gout should not take cyclosporine. Women who are breast-feeding and people who are undergoing radiation treatment should also avoid this medication.
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