There are many injectable medication options to treat psoriatic arthritis. You can talk with your doctor to determine which one may be best for you.

If your psoriatic arthritis (PsA) is moderate to severe and other treatments have not helped, your doctor may want to prescribe an injectable treatment such as a biologic.

Many people with PsA develop joint damage over time. In that case, an injectable biologic may be the best option, as it could prevent further damage to your joints and even put your PsA into remission.

It’s important to learn about and understand these medications before starting one. Here are a few questions to ask your doctor before starting an injectable treatment for PsA.

In recent years, many new drugs have been approved to treat PsA. You can speak with your doctor about your options.

Injectable treatment means that the drug will be injected directly into your body. This differs from the oral route, in which the medication is taken by mouth and digested.

Injectables are given in one of two ways:

  • Intravenous (IV) infusion: The medication is delivered directly into a vein through a small plastic tube.
  • Needle injection: You receive the medication as either an intramuscular (IM) injection (into a muscle) or a subcutaneous (SQ) injection (into skin tissue).

Methotrexate (Otrexup, Rasuvo, Trexall) was once commonly prescribed for PsA. It’s part of a drug class called disease-modifying antirheumatic drugs (DMARDs). It’s now primarily prescribed only if peripheral arthritis is severe and persists despite biologic treatment. It is commonly taken by mouth but can also be given by injection.

There are many injectable biologic medications currently approved to treat PsA, including:

Ask your doctor to explain the similarities and differences between these medications. If your doctor already has a particular biologic in mind, ask them why they chose that one first.

Many biologics have approved biosimilar versions that may be prescribed or substituted by your pharmacist, depending on your insurance coverage.

Each injectable biologic — whether it’s given by IV infusion, IM injection, or SQ injection — has a different dosing regimen. Some are given once or twice per week, while others are infused once per month.

For example, infliximab is dosed as three IV infusions during the first 6 weeks and then one infusion every 6 to 8 weeks after that.

Ask your doctor about the different doses for each biologic. When making a decision, consider your personal preferences and your schedule.

An IV infusion can seem overwhelming and scary. Ask your doctor about the process, including how long it will last and how it will feel.

Most biologic medications come in prefilled syringes that you can use to give yourself SQ injections at home. Ask your doctor whether they recommend one of these medications. You’ll need training to learn the proper technique for preparing and injecting the solution.

Many of the biologic agents for PsA target your immune system, decreasing your body’s ability to fight off infections. Because of this, you’ll need frequent testing and monitoring to make sure you don’t have any infections.

Before taking any biologics, you’ll be tested for tuberculosis, HIV, hepatitis, and other bacterial or fungal infections. You may need to get a vaccine against hepatitis B and tuberculosis before you start taking a biologic.

Your doctor will likely also need to check your liver function and blood count. If you start a biologic, ask your doctor how often you’ll need to come in for a blood test.

All medications that treat PsA can cause side effects. Whether you might experience side effects or not, it’s important to assess the pros and cons of the drug with your doctor.

Some of the most common side effects of biologic agents are:

  • upper respiratory infections
  • increased risk of mild to serious infections
  • headaches
  • swelling, pain, or rash at the injection site
  • stomach pain
  • fatigue

The most common side effects of methotrexate include:

  • nausea
  • vomiting
  • fatigue
  • headache
  • mouth sores
  • trouble sleeping
  • lightheadedness
  • liver damage

You may begin to notice some improvement after the first or second injection and a bigger improvement within 4 to 6 weeks. Before you begin an injectable treatment, ask your doctor how soon you can reasonably expect to feel better.

Some biologics can help get your PsA into remission. Talk with your doctor to find out which treatment will give you the best chance of this.

Most rheumatologists recommend that you continue biologic therapy even if your symptoms disappear. It’s important to remember that while injections often work well, they don’t cure the underlying disease. Your doctor can give you a more definitive answer.

Your insurance may cover only some biologic agents for PsA. In general, the drug you receive will usually depend on which medication your insurance provider prefers. You may need to complete paperwork or pay a higher copay to get insurance coverage for other medications.

Ask your doctor’s office for confirmation from your insurance company that it will cover the injectable medication you choose.

You can ask your doctor for information about copay assistance. The pharmaceutical company that makes your chosen medication may offer a financial assistance program.

Patient assistance copay foundations also help people who qualify with out-of-pocket medical expenses such as prescription copays. Most have income requirements related to the national poverty levels.

Some examples of copay foundations are the Patient Advocate Foundation Co-Pay Relief Fund and the Psoriatic Arthritis Copay Assistance Program. Your doctor can help you find other copay foundations that may help you.

If you take an injectable and your symptoms don’t improve, or if your side effects are too severe, your doctor might want to switch you to a different type of biologic.

For example, doctors will not usually prescribe ustekinumab unless your symptoms don’t improve with TNF inhibitors (such as adalimumab or etanercept) or unless you experience severe side effects.

The goal of injectable medications is to manage PsA symptoms and to prevent permanent joint damage.

Ultimately, the injectable your doctor prescribes will depend on your particular condition, your insurance coverage, and your preference for how often you’ll need infusions.

Because biologics target your immune system, they increase your risk of serious infections. Talk with your doctor about the risks and benefits of injectable treatments.