What is the best med for psoriatic arthritis? A Comprehensive Guide

Approximately 30% of people with psoriasis will also develop psoriatic arthritis (PsA), a chronic inflammatory condition affecting the joints [1.2.2]. The crucial question for many is, 'What is the best med for psoriatic arthritis?' The answer is highly individualized.

Quick Summary

There is no single 'best' medication for psoriatic arthritis; treatment is tailored to symptom severity and patient-specific factors. Options range from NSAIDs for mild cases to DMARDs, biologics, and JAK inhibitors for more advanced disease.

Key Points

• No Single Best Med: The best medication for psoriatic arthritis is highly individualized and depends on symptom severity, location, and patient health [1.2.5].

• Treatment Goals: Treatment aims to reduce inflammation, manage pain, prevent joint damage, and improve quality of life using a 'treat-to-target' strategy [1.2.1, 1.3.2].

• Initial Therapy: Mild PsA is often managed with Nonsteroidal Anti-inflammatory Drugs (NSAIDs) for symptom relief, but they don't halt disease progression [1.4.5, 1.5.1].

• Standard Care: Conventional DMARDs like methotrexate are a cornerstone of treatment, working to slow the disease by suppressing the immune system [1.2.1, 1.6.3].

• Targeted Biologics: For moderate-to-severe disease, biologics (like TNF, IL-17, or IL-23 inhibitors) target specific inflammatory pathways and are highly effective [1.3.2, 1.4.1].

• Oral Options: Newer targeted oral therapies, including JAK inhibitors (Tofacitinib) and PDE4 inhibitors (Apremilast), provide alternatives to injections but have unique risk profiles [1.2.1, 1.8.2].

• Consult a Specialist: Choosing a medication requires a thorough evaluation and ongoing partnership with a rheumatologist to tailor the therapy to your specific needs [1.2.5].

Understanding Psoriatic Arthritis Treatment

Psoriatic arthritis (PsA) is a complex autoimmune disease that causes joint inflammation and often accompanies the skin condition psoriasis [1.2.2]. There is no cure, but the goal of treatment is to manage symptoms, reduce inflammation, prevent joint damage, and improve quality of life [1.2.1]. Determining the best medication depends on the severity of your symptoms, which joints are affected, the extent of skin involvement, and your overall health [1.2.1, 1.2.5]. Treatment often follows a 'treat-to-target' strategy, where you and your rheumatologist set specific goals and adjust medications to reach them [1.3.2].

Initial and Mild Symptom Management

For individuals with mild PsA, the first line of defense is often Nonsteroidal Anti-inflammatory Drugs (NSAIDs) [1.4.5]. These medications help relieve pain and reduce swelling [1.2.1].

• Over-the-the-counter (OTC) options: Ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) are commonly used [1.2.1, 1.5.4].
• Prescription NSAIDs: For more persistent symptoms, a doctor might prescribe stronger NSAIDs like celecoxib (Celebrex) or meloxicam (Mobic) [1.2.4].

While effective for symptom relief, NSAIDs do not slow the progression of the disease or prevent long-term joint damage [1.5.1]. Long-term use can also lead to side effects like stomach irritation, heart problems, and kidney issues [1.2.1, 1.5.2]. For localized flares, corticosteroid injections directly into a painful joint can provide rapid, short-term relief [1.2.1].

Conventional Disease-Modifying Antirheumatic Drugs (cDMARDs)

When NSAIDs are not enough or if the disease is more active, doctors prescribe conventional Disease-Modifying Antirheumatic Drugs (cDMARDs). These medications work to suppress the body's overactive immune system, slowing down the disease process and helping to prevent permanent joint damage [1.2.1, 1.6.3].

• Methotrexate (Trexall, Otrexup): This is the most common cDMARD used for PsA [1.2.1]. It is often taken once a week as a pill or injection and can help both joint and skin symptoms [1.2.4, 1.4.3].
• Leflunomide (Arava): This is another oral cDMARD that can improve joint and skin symptoms [1.4.3].
• Sulfasalazine (Azulfidine): This drug is effective for peripheral arthritis but has less evidence for inhibiting joint damage [1.4.3].

cDMARDs can take several weeks or months to become fully effective and require regular monitoring for side effects, which can include liver damage and bone marrow suppression [1.2.1, 1.6.3].

Biologic DMARDs: Targeted Therapy

For moderate to severe PsA, or when cDMARDs are ineffective, biologic drugs are a powerful option. These are complex proteins derived from living cells that target very specific parts of the immune system responsible for inflammation [1.2.1, 1.6.3]. They are typically administered via injection or intravenous (IV) infusion [1.5.1]. According to joint guidelines from the American College of Rheumatology (ACR) and the National Psoriasis Foundation (NPF), a TNF inhibitor biologic is often recommended as a first-line therapy for active PsA [1.3.2].

• TNF-alpha Inhibitors: This is the most common class of biologics. They block a protein called tumor necrosis factor-alpha (TNF-alpha), a major driver of inflammation. Examples include:
  • Adalimumab (Humira) [1.2.1]
  • Etanercept (Enbrel) [1.2.1]
  • Infliximab (Remicade) [1.2.1]
  • Golimumab (Simponi) [1.2.1]
  • Certolizumab pegol (Cimzia) [1.2.1]
• IL-17 Inhibitors: These drugs block Interleukin-17, another protein that signals inflammation. They can be very effective for both joint and skin symptoms. Examples include Secukinumab (Cosentyx) and Ixekizumab (Taltz) [1.2.1, 1.4.1]. The newest approved drug in this class, Bimekizumab (Bimzelx), inhibits both IL-17A and IL-17F [1.9.2].
• IL-12/23 Inhibitors: These target Interleukins 12 and 23. Ustekinumab (Stelara) is a primary example [1.2.1]. Newer agents that target only IL-23, like Guselkumab (Tremfya) and Risankizumab (Skyrizi), have also been approved and show impressive efficacy, particularly for skin disease [1.4.5, 1.11.2].
• Selective Costimulation Modulators: Abatacept (Orencia) works by targeting T-cells to block the communication that leads to inflammation [1.2.2].

Biologics can significantly increase the risk of infection, so screening for tuberculosis and other infections is required before starting treatment [1.2.1, 1.7.3].

Oral Targeted Therapies: JAK Inhibitors and PDE4 Inhibitors

In recent years, new oral medications have become available that offer targeted treatment without the need for injections.

• Janus Kinase (JAK) Inhibitors: These are small molecule drugs that work inside cells to block the JAK-STAT signaling pathway, interrupting inflammatory signals [1.8.2, 1.8.4]. They can be used when biologics haven't worked. Approved JAK inhibitors for PsA include Tofacitinib (Xeljanz) and Upadacitinib (Rinvoq) [1.8.2]. However, the FDA has issued warnings about an increased risk of serious heart-related events, cancer, and blood clots with these medications [1.2.1, 1.8.4].
• Phosphodiesterase 4 (PDE4) Inhibitors: Apremilast (Otezla) is an oral medication that works by blocking the PDE4 enzyme inside immune cells to decrease inflammation [1.2.2]. It is generally used for mild to moderate PsA and may be an option for those who cannot or do not want to take biologics [1.2.1]. Common side effects include diarrhea and nausea [1.2.1].

Comparison of Psoriatic Arthritis Medication Classes

Drug Class	Mechanism	Examples	Administration	Key Considerations
NSAIDs	Reduces pain and inflammation	Ibuprofen, Naproxen, Celecoxib [1.2.1, 1.2.4]	Oral	For mild symptoms; does not slow disease progression [1.5.1].
cDMARDs	Broadly suppresses immune system	Methotrexate, Leflunomide [1.2.1]	Oral, Injection	Slows disease progression; requires monitoring for liver/blood side effects [1.2.1].
TNF Inhibitors	Blocks TNF-alpha protein	Adalimumab (Humira), Etanercept (Enbrel) [1.2.1]	Injection, IV	Often first-line biologic; increased risk of infection [1.3.2, 1.2.1].
IL-17 Inhibitors	Blocks IL-17 protein	Secukinumab (Cosentyx), Ixekizumab (Taltz) [1.2.1]	Injection	Very effective for skin and joints; may worsen IBD [1.7.1, 1.11.2].
IL-12/23 Inhibitors	Blocks IL-12 and/or IL-23 proteins	Ustekinumab (Stelara), Guselkumab (Tremfya) [1.2.1]	Injection	Effective for skin and joints; generally well-tolerated [1.11.2].
JAK Inhibitors	Blocks JAK enzymes inside cells	Tofacitinib (Xeljanz), Upadacitinib (Rinvoq) [1.8.2]	Oral	Oral alternative to biologics; carries warnings for heart issues, clots, cancer [1.8.4].
PDE4 Inhibitor	Blocks PDE4 enzyme	Apremilast (Otezla) [1.2.1]	Oral	For mild-to-moderate disease; common GI side effects [1.2.1].

Conclusion

Ultimately, there is no single 'best' medication for everyone with psoriatic arthritis [1.2.5]. The optimal treatment is a personalized decision made in partnership with a rheumatologist. The choice will be guided by your specific symptoms (peripheral arthritis, axial disease, enthesitis, skin/nail involvement), disease severity, other health conditions, and personal preferences [1.4.3, 1.2.5]. The landscape of PsA treatment is continually evolving, with new and more targeted therapies offering hope for achieving remission and maintaining a high quality of life [1.9.3].

For more information, you can visit the Arthritis Foundation.

Frequently Asked Questions

What is the first-line treatment for psoriatic arthritis?

For mild psoriatic arthritis (PsA), nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first treatment [1.4.5]. For more active or moderate-to-severe PsA, treatment guidelines often recommend starting with a biologic TNF inhibitor, sometimes over oral medications [1.3.2].

Are biologics better than DMARDs for psoriatic arthritis?

Biologics are a type of DMARD that target specific parts of the immune system, whereas conventional DMARDs (cDMARDs) like methotrexate are more broad [1.6.3]. Biologics are typically used for moderate-to-severe disease or when cDMARDs are not effective enough [1.4.5]. They are not necessarily 'better' but are more targeted and powerful.

What is the newest drug for psoriatic arthritis?

Bimekizumab (Bimzelx), an inhibitor of both IL-17A and IL-17F, was approved for PsA in late 2024 [1.9.2]. Additionally, Deucravacitinib, an oral TYK2 inhibitor, is currently under FDA review for PsA with a goal date in March 2026 [1.9.3].

Can psoriatic arthritis be treated with pills only?

Yes, several oral medications are available. These include NSAIDs, conventional DMARDs like methotrexate, the PDE4 inhibitor apremilast (Otezla), and targeted synthetic DMARDs known as JAK inhibitors, such as tofacitinib (Xeljanz) [1.2.1, 1.2.3, 1.8.2].

What are the most common side effects of psoriatic arthritis medications?

Side effects vary by drug class. NSAIDs can cause stomach upset [1.2.1]. Methotrexate can affect the liver [1.2.1]. Biologics and JAK inhibitors suppress the immune system, increasing the risk of infections [1.7.3, 1.8.2]. Apremilast (Otezla) commonly causes diarrhea and nausea [1.2.1].

How long does it take for psoriatic arthritis medications to work?

This varies. NSAIDs can provide relief quickly. Conventional DMARDs like methotrexate can take several weeks to months to show their full effect [1.5.1]. Some biologics and JAK inhibitors can show improvements in as little as two weeks for some patients, though it can take three months or more for others [1.2.3].

Do I have to take medication for psoriatic arthritis for the rest of my life?

Psoriatic arthritis is a chronic disease with no cure, so long-term treatment is typically necessary to control symptoms and prevent joint damage [1.2.1]. The goal is to find a medication that achieves remission, meaning the disease is not active, which you would continue taking [1.2.3, 1.2.5].