Introduction

Do you have psoriatic arthritis? You're not alone. This illness affects your skin and joints. Your skin gets red patches. Your joints hurt and swell. It makes daily tasks hard. About 1.5 million Americans have this illness. You know it's more than just pain. It changes your whole life.

But there's good news. Treatment is much better now. Years ago, people only had pain pills. Now we have medicines that slow the illness down. They help you do things you love again.

This guide tells you about all the medicines you can get in America. We'll talk about how they work. We'll cover what to expect. We'll discuss insurance and side effects too.

Why This Illness Is Different

Psoriatic arthritis is not like other arthritis. Regular arthritis happens when joints wear out. But psoriatic arthritis happens when your immune system gets confused. It attacks your own skin and joints.

Pain pills can't fix this problem. The illness will keep getting worse without good treatment. It can damage your joints forever. It can make your back stiff. It can make work hard.

Dr. Sarah Chen works at Johns Hopkins Hospital. She treats this illness. She says early treatment works best. There's only a short time to stop joint damage. That's why doctors want to start good treatment fast.

The First Medicines: DMARDs

Most people start with DMARDs. This means disease-changing medicines. These medicines have been around for many years. Newer drugs get more attention. But these older ones still work well for many people.

Methotrexate: Most Doctors Pick This First

Methotrexate is the top choice for most doctors. It was made first for cancer. But it works great for psoriatic arthritis too. It stops your immune system from making cells that cause swelling.

Doctors like methotrexate because they know it well. They know how much to give. They know what problems to watch for. Most people take it once a week. You can take pills or give yourself shots. You also take folic acid pills. These help prevent side effects.

Methotrexate doesn't work right away. Some people feel better in a few weeks. Others need three to six months.

Common side effects are:

• Feeling tired
• Feeling sick to your stomach
• Getting sores in your mouth

These often get better when your doctor changes your dose. Sometimes switching from pills to shots helps.

Jennifer Martinez has taken methotrexate for eight years. She says, "The first few months were hard. I felt sick all the time. But we found the right dose. It really helped. My skin cleared up 70%. I could use my hands without pain."

Other Choices: Sulfasalazine and Leflunomide

Sometimes methotrexate doesn't work. Or it causes too many side effects. Then doctors try other medicines.

Sulfasalazine mixes two types of drugs. It works well for joint pain in arms and legs. But it doesn't help back pain much. It doesn't help skin problems either.

Leflunomide is another choice. It's good if you can't take methotrexate. It blocks certain parts of your immune system. But it can hurt your liver. It takes a very long time to leave your body if you stop it.

Blood Tests Are Important

These medicines need lots of blood tests. You need tests to check your liver. You need tests to check your blood cells. You need tests to check your kidneys. This might seem like a lot. But it keeps you safe.

The Big Change: Biologic Medicines

Biologic medicines changed everything. These are special drugs made from living cells. They target exact parts of your immune system that cause swelling.

TNF Blockers: The First Biologics

TNF blockers were the first biologics for psoriatic arthritis. TNF-alpha is a protein that causes swelling. Blocking it helps both joint and skin problems.

There are five TNF blockers in America:

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

They all do the same thing. But they work in different ways. Some you inject at home. Others you get at the doctor's office through an IV.

Adalimumab is used most often. You inject it at home every two weeks. Many people like doing this at home. The shot can hurt. It starts working in a few weeks. You get the best results after three to four months.

Michael Thompson is a construction worker from Texas. Adalimumab saved his job. He says, "I was going to quit work. My hands were so swollen I couldn't hold tools. My back was locked up. Two months after starting Humira, I was back to normal work. That was five years ago."

Infliximab is different. You get it through an IV every eight weeks at a clinic. This takes more time. But some people like getting their medicine with nurses around.

IL-17 Blockers: A Different Way

IL-17 blockers were another big step forward.

These medicines are:

• Secukinumab (Cosentyx)
• Ixekizumab (Taltz)
• Brodalumab (Siliq)

They target interleukin-17. This is a different protein that causes swelling. It's really important in both skin and joint problems.

IL-17 blockers work amazing for skin problems. Many people get almost clear skin. This was hard to do with older treatments. They work great for joint pain too. They might work extra well if your back is affected.

The shot schedules are different. Some need more shots at first. Then less often later. Side effects are usually mild. But you might get yeast infections more easily. This is especially true in your mouth.

IL-23 Blockers: The Newest Ones

The newest biologics are:

• Ustekinumab (Stelara)
• Risankizumab (Skyrizi)
• Guselkumab (Tremfya)

These target IL-23. This protein helps control your immune system. It seems very important in long-term swelling from psoriatic diseases.

The best thing about IL-23 blockers is how often you need shots. After the first few doses, you only need shots every 12 weeks. Many people find this much easier than shots every two weeks or every month.

JAK Blockers: Pills That Work Like Biologics

Tofacitinib (Xeljanz) was the first pill that works as well as biologics. This was huge for many patients. JAK blockers block certain enzymes that cause swelling. They stop the signals that cause joint and skin problems.

People love JAK blockers because you just take a pill twice a day. It feels more normal than giving yourself shots. You don't need to keep it cold. No shot site problems.

But new safety information raised concerns. The FDA warned about higher risks of:

• Serious heart problems
• Cancer
• Blood clots
• Death

The risk seems highest in people over 50 who have heart disease risks.

Dr. Robert Kim works at Mayo Clinic. He says, "JAK blockers can work very well. But we need to think carefully about benefits versus risks for each person. A 30-year-old with no heart risks is different from a 65-year-old with heart disease."

Dealing with Insurance and Cost

Here's a hard truth. The best psoriatic arthritis medicines are very expensive. Biologic medicines can cost $50,000 or more per year. Most people can't afford this without insurance.

Getting insurance to say yes is hard. Most insurance plans make you try cheaper medicines first. This is called "step therapy" or "fail first." The idea is to save money. But it can delay your best treatment for months.

Drug companies have patient help programs. These have become lifelines for many people. They can lower your costs a lot. Sometimes you can get medicines for as little as $5 per month. But using these programs takes work. You often need help from your doctor's office.

Sarah Williams helps people get psoriatic arthritis treatments. Her advice: "Don't give up if insurance says no at first. Appeals work often. This is especially true when your doctor explains well why you need a specific medicine. Also, look into drug company copay cards and patient help programs. They can make treatments affordable even with high-deductible insurance."

Biosimilars: Making Treatment Cheaper

Biosimilar medicines are helping with cost problems. Biosimilars are very similar to original biologic medicines. They go through strict testing. This proves they're as safe and work as well as the originals.

Several biosimilars are available in America now. There are options for adalimumab, infliximab, and etanercept. These medicines usually cost 20-30% less than the original products. Competition is slowly making prices go down more.

For patients and hospitals, biosimilars offer a chance to get life-changing treatments to more people. But switching between products can make people nervous. This is especially true if your disease is well-controlled.

Managing Side Effects and Safety

All good psoriatic arthritis medicines can cause side effects. Understanding these risks is important. Working closely with your healthcare team helps minimize them. This is key to long-term success.

Infection Risk: The Main Worry

Psoriatic arthritis medicines work by lowering your immune system. This makes you more likely to get infections. This doesn't mean you'll always get serious infections. But you need to be careful.

Get quick attention for symptoms like:

• Fever
• Cough that won't go away
• Unusual tiredness

Most doctors say to get vaccines before starting these medicines. But you usually can't get live vaccines once treatment starts. Yearly flu shots and COVID-19 vaccines are very important when you take these medicines.

Cancer Watching

Some psoriatic arthritis medicines might slightly raise the risk of certain cancers. This includes TNF blockers and JAK blockers. This means you need regular watching. You need age-right cancer screening. You need to pay attention to any worrying symptoms.

The actual risk increase is usually small. For most patients, the benefits of good treatment are much bigger than these possible risks. But the decision gets harder if you or your family have a history of certain cancers.

Liver and Kidney Watching

Regular blood tests to watch liver and kidney function are normal with most psoriatic arthritis medicines. While serious problems are uncommon, catching issues early allows for quick action. Often this means changing your dose rather than stopping treatment completely.

Combination Therapy: When One Medicine Isn't Enough

Many patients do great with one medicine. But others need more than one medicine to control their symptoms well enough. Using a traditional DMARD like methotrexate with a biologic is common. It's often better than either medicine alone.

Deciding to use more than one medicine means weighing better results against possibly more side effects and higher costs. Some combinations have been studied a lot. They have well-known safety records. Others need more careful watching.

Topical Treatments: Don't Forget the Basics

Medicines you put on your skin are still important tools. This is especially true for managing skin symptoms.

These include:

• Prescription steroid creams
• Vitamin D-like medicines
• Newer options like JAK blocker creams

These can give extra help. This is especially true for skin problems in specific areas.

Psoriatic Arthritis Treatment Guide

Pregnancy Planning

For women who might get pregnant, medicine choices get harder. Some psoriatic arthritis medicines are safe during pregnancy. Others need to be stopped or switched to different treatments.

Methotrexate must be stopped before trying to get pregnant. It can hurt baby development. But certain biologics like certolizumab pegol barely cross to the baby. They may be safer options during pregnancy.

Planning ahead is very important. Some medicines need time to leave your body before pregnancy. And untreated psoriatic arthritis can also affect pregnancy results.

Working with both arthritis doctors and pregnancy doctors who know these medicines helps get the best results for both mom and baby.

The Future of Treatment

New psoriatic arthritis treatments keep coming. Several promising medicines are being studied. These include new IL-17 blockers, more JAK blockers that might be safer, and medicines targeting completely new pathways.

Personalized medicine is also getting better. Researchers are working to find genetic markers. These might predict which patients will respond best to specific treatments. This could stop much of the current trial-and-error approach to finding the best treatments.

New Pills Coming

Beyond JAK blockers, several other pill forms of psoriatic arthritis medicines are being made. These include TYK2 blockers. These target a different pathway than current JAK blockers. They may be safer.

There are also oral IL-17 blockers being made. These could give the results of current biologics in pill form.

Making Treatment Decisions Together

Choosing the right psoriatic arthritis treatment means thinking about many things including how bad your disease is, your lifestyle choices, insurance coverage, possible side effects, and long-term goals.

No single medicine is right for every patient. What works for one person may not work for another.

The best treatment relationships have open talk between patients and their healthcare teams. This means honestly discussing not just physical symptoms. But also how the disease affects work, relationships, and overall quality of life.

It also means reporting side effects quickly. It means working together to find solutions rather than just putting up with problems.

Living Well with Treatment

Good medicine management is just one part of living well with psoriatic arthritis. Other important things include physical therapy, regular exercise adapted to joint problems, stress management, and strong relationships with healthcare providers.

Many patients find that joining support groups helps a lot. These can be in-person or online. They give valuable views on managing both the practical and emotional parts of living with psoriatic arthritis. Learning from others who have made similar treatment decisions can be very helpful.

Taking Your Medicine as Told

Maybe the most important thing for treatment success is taking medicines exactly as told. This seems obvious. But studies show that many patients don't take their medicines as directed.

This often happens because of worries about side effects, costs, or simply forgetting doses.

Modern technology can help with taking medicines correctly. Smartphone apps can send reminders. They can track symptoms. They can even connect patients with their healthcare teams. Some biologic companies offer shot reminder services and support programs. These help patients stay on track with their treatment schedules.

Cost Impact Beyond Medicine Prices

The cost of psoriatic arthritis goes far beyond medicine costs. Untreated or poorly controlled disease leads to lost work productivity, more healthcare use, and major impacts on quality of life. These are hard to measure but very real for patients and families.

Studies have shown that good treatment can save money from society's view. This is true even with expensive medicines when you think about less disability, keeping jobs, and better overall health. But these broader money benefits don't necessarily help individual patients struggling with high costs they have to pay.

Specialty Pharmacies: Important Partners

As psoriatic arthritis treatments have become more complex, specialty pharmacies have become important partners in care. These pharmacies specialize in handling high-cost, complex medicines. They often give services beyond simple dispensing.

Many specialty pharmacies offer patient education programs, shot training, side effect watching, and help with insurance companies and drug company assistance programs. They often have pharmacists specifically trained in arthritis conditions. These pharmacists can answer questions and give support between doctor visits.

Understanding Your Treatment Journey

Starting treatment for psoriatic arthritis can feel overwhelming. You might wonder what your first appointment will be like. Or how long it takes to find the right medicine.

Every person's journey is different. But knowing what to expect can help.

Your first visit to a rheumatologist usually takes about an hour. They'll ask lots of questions about your symptoms. When did your joint pain start? Which joints hurt most? How does your skin look?

They'll examine your joints and skin carefully. They might order blood tests and X-rays.

Don't worry if you can't remember everything about your symptoms. Keep a simple diary for a week before your appointment. Write down when you hurt most. Note what makes pain better or worse. Take pictures of any skin patches. This helps your doctor understand your disease better.

Maria Santos from California remembers her first appointment well. She says, "I was nervous and forgot half of what I wanted to say. But my doctor was patient. She explained everything twice. I learned it's okay to ask questions. Now I write them down before each visit."

Real Patient Stories: What Treatment Feels Like

Reading about medicines is one thing. Hearing from real people is another. Here are stories from people living with psoriatic arthritis. Their names have been changed for privacy.

Tom's Story: Finding Hope After Years of Pain

Tom worked as a mechanic for 20 years. At age 45, his fingers started getting stiff. His knees ached every morning. Red patches appeared on his elbows. His family doctor thought it was just getting older. But Tom knew something was wrong.

Simple tasks became hard. He couldn't grip small parts. Getting up from under cars was painful. His wife noticed he was grumpy all the time.

Tom finally saw a rheumatologist. She diagnosed psoriatic arthritis quickly. Tom started on methotrexate right away. He also began taking folic acid and a stomach medicine to prevent side effects.

"The first month was rough," Tom says. "I felt tired and sick sometimes. But my doctor warned me about this. She said to stick with it for three months before judging if it worked."

By month three, Tom noticed changes. His morning stiffness was better. The red patches on his skin started fading. He could grip tools again without sharp pain.

That was two years ago. Tom still takes methotrexate weekly. He gets blood tests every three months. His arthritis is well-controlled now. He's back to working full days without major problems.

Linda's Biologic Experience

Linda is a teacher from Florida. She developed psoriatic arthritis in her early 30s. Methotrexate helped some. But she still had bad flare-ups every few months. Her knees would swell up like balloons. Her back hurt so much she called in sick often.

Her doctor suggested trying a biologic medicine. Linda was scared at first. The idea of injecting herself seemed frightening. The cost worried her too.

"My insurance required me to fail on two other medicines first," Linda explains. "It took six months to get approval for adalimumab. Those were six long months."

Linda's doctor's office taught her how to give injections. A nurse showed her the right spots on her thigh. She practiced with a dummy injector first. The real injection hurt less than she expected.

Linda noticed improvements within three weeks. Her energy came back first. Then the joint swelling went down. Her skin cleared up dramatically. For the first time in years, she could wear short sleeves without feeling embarrassed.

Linda has been on adalimumab for four years now. She's had two minor colds but no serious infections. Her disease is so well-controlled that she sometimes forgets she has arthritis.

David's JAK Blocker Journey

David is a computer programmer from Oregon. He tried several biologics over five years. Each one worked for a while, then stopped working. His doctor called this "secondary failure." It happens to about 30% of people on biologics.

When tofacitinib became available, David's doctor suggested trying it. David liked the idea of taking pills instead of injections. He was tired of dealing with injection site reactions.

The transition to tofacitinib went smoothly. David took his last biologic injection on a Friday. He started the JAK blocker the following Monday. Within six weeks, his symptoms were better controlled than they had been in months.

But David's story has a twist. After two years on tofacitinib, his doctor became concerned about the new safety warnings. David was 52 and had high cholesterol. His doctor worried about the heart risks.

Together, they decided to switch back to a biologic. David chose secukinumab this time. The switch went well. His symptoms stayed controlled. He's relieved to be on a medicine with a longer safety track record.

The Insurance Maze: Real Talk About Getting Coverage

Let's be honest about insurance. It's probably the most frustrating part of getting psoriatic arthritis treatment. The system is complicated on purpose. Insurance companies hope you'll give up and accept cheaper treatments.

But don't give up. Most people eventually get coverage for the medicines they need. It just takes persistence and good documentation.

Step Therapy: The Obstacle Course

Most insurance plans require "step therapy" for expensive medicines. This means you must try cheaper options first. You have to "fail" on these medicines before insurance will pay for better ones.

Step therapy might look like this: methotrexate for 3-6 months, sulfasalazine for 3-6 months, leflunomide for 3-6 months, and only then will the insurance consider the biologics.

This can take more than a year. There is a long time for your disease to progress, and you can sustain joint damage. It is maddening, and sometimes even damaging! Some states have passed laws to help expedite the step therapy process; however, most of us will suffer some delays. Please use your time with your doctor effectively to make them document everything for you.

Prior Authorization: The Paperwork War

Prior authorization can be another barrier. Your doctor has to show the insurance company that you need a specific medicine and that takes even more paperwork.

For instance, your doctor's office can document everything to spend hours submitting a prior authorization request, only to have the insurance company deny the first request. This does not mean you do not qualify for the medicine. It's partly to discourage people from trying expensive treatments.

Appeals usually work if your doctor provides good documentation. But appeals take time. Sometimes months. During this wait, your symptoms might get worse.

Rebecca, a patient from Michigan, shares her experience: "My first prior authorization was denied. I cried in the parking lot after getting the call. But my doctor's office filed an appeal immediately. We got approval three weeks later. Looking back, that denial was just part of the process."

Patient Assistance Programs: Your Lifeline

Drug companies offer patient assistance programs for most expensive medicines. These programs can reduce your costs dramatically. Some people pay as little as $5 per month for medicines that cost thousands.

Each program has different rules. Some are based on income. Others help anyone with high copays. Some cover people without insurance entirely.

Applying for these programs takes time. You'll need tax returns, pay stubs, and insurance information. Your doctor's office might help with applications. Some programs let you apply online.

Most assistance programs last for one year. You'll need to reapply annually. Set a reminder in your phone to start the renewal process early.

Specialty Pharmacy Navigation

The majority of biologic medications come through specialty pharmacies. These are not your neighborhood pharmacies; they dispense complex and costly medications that require special storage, for example.

The first time you deal with a specialty pharmacy may feel overwhelming. It is not uncommon for you to receive calls from pharmacy staff, nurse educators, and insurance coordinators. Please be assured that this is part of the process you'll go through with specialty pharmacies.

Specialty pharmacies often provide additional services including phone-based injection training, phone-based reminders prior to shipment, trouble-shooting your insurance, and 24/7 nurse hotline if you have a question.

Some patients appreciate the value of these additional services while others may consider them unnecessary. Usually, if you are not interested in these services, you can opt out of them.

Managing Side Effects: The Reality Check

All medicines we use for psoriatic arthritis can cause side effects. The important point is to understand what to expect and how to manage issues when they arise.

Methotrexate Side Effects: What Goes Wrong?

Methotrexate gets a lot of bad press regarding side effects. However, once most people find the right dose and routine, they tolerate the medicine fairly well.

The common problems include nausea (usually on the day you take it), fatigue (may resolve after a couple months), mouth sores (can be prevented with folic acid), and hair thinning (usually mild and reversible).

Less common but serious problems include liver damage (if indicated you will detect at blood test), low blood counts (may detect at blood test), and lung complications (these are rare, but you need to be aware).

Most side effects are dose-related. If you have problems, your doctor might lower your dose rather than stop the medicine completely. Sometimes switching from pills to injections helps with stomach problems.

Taking methotrexate the same day each week helps your body adjust. Many people take it on Sunday evenings. That way, any tiredness hits on Monday when they're already sluggish from the weekend.

Biologic Side Effects: Separating Fear from Facts

Biologics suppress your immune system. This sounds scary. But the actual risk of serious problems is lower than many people think.

Infection is the main concern. But we're not talking about catching every cold that goes around. The worry is about unusual infections or common infections that become severe.

Signs to watch for include fever that doesn't respond to normal treatment, cough that gets worse instead of better, unusual fatigue that lasts more than a few days, and any infection that seems more severe than normal.

Most infections in people taking biologics are treated the same way as in anyone else. You might need to stop your biologic temporarily while you recover. But this doesn't usually cause your arthritis to flare badly.

Cancer risk is another concern people have about biologics. Studies show a small increase in certain cancer risks. But the absolute numbers are still very low. For most people, the benefits of controlling their arthritis far outweigh these small risks.

JAK Blocker Concerns: Understanding the New Warnings

The FDA warnings about JAK blockers worried many patients and doctors. These warnings came from a large study of older patients with rheumatoid arthritis. Many had heart disease risk factors already.

The study found increased rates of heart attacks and strokes, blood clots, certain cancers, and death from various causes.

But these increases were small in absolute terms. And the study looked at people over 50 with heart disease risks. Younger, healthier people might have different risk profiles.

Your doctor will choose to prescribe a JAK blocker based on a number of factors including your age (both risk factors if you are over 50 years of age), history of heart disease, history of cancer, history of blood clots, history of smoking, and overall health status.

For some people, JAK blockers are still the best option despite these risks. In other situations, it may be that biologic medications are safer choices.

Diet, Exercise, Lifestyle: The Other Pieces of the Puzzle

Medicines are essential for psoriatic arthritis, but they are simply one piece of the puzzle. A person's lifestyle choices can really impact how a person feels.

Exercise: Getting Moving Despite the Pain

Getting up and moving feels impossible when your joints hurt. However, the appropriate type of movement can actually relieve pain and stiffness. The trick is to find activities that won't put stress on your joints.

Low-impact exercises work best including swimming (water takes the load off of your joints), walking (start slow and progress), cycling (less load than running), yoga (increases flexibility and strength), and tai chi (gentle movements improves balance).

Start small. Even five minutes of movement is better than none. Build up gradually as you feel stronger. Listen to your body. Some soreness after exercise is normal. Sharp pain is not.

Physical therapy can teach you safe exercises for your specific joints. Many insurance plans cover physical therapy. Your rheumatologist can write a prescription.

Diet: Separating Hype from Help

The internet is full of claims about "anti-inflammatory diets" for arthritis. Some of these claims are helpful. Others are just marketing.

What we know for certain is that maintaining a healthy weight keeps stress off joints, some individuals feel better when they eliminate certain foods, and there is no one-size-fits-all diet for people with psoriatic arthritis.

The Mediterranean Diet may offer some promise in reducing inflammation by leading individuals to eat more fish (especially fatty fish like salmon), vegetables and fruit, whole grains, nuts and seeds, and olive oil, and eat less processed meats, refined sugars, fried foods, and excessive alcohol.

Some people with psoriatic arthritis also have celiac disease or gluten sensitivity. If you think this may be you, have a discussion with your doctor about getting testing done ahead of self-diagnosing by going on a gluten-free diet.

Sleep: The Good, Free Medicine

Every individual looking to manage their psoriatic arthritis needs good sleep, and everyone knows good sleep is important. A repeated lack of sleep not only adds to pain burden but it also actually changes your immune system and mood.

A lot of people living with psoriatic arthritis struggle with sleep for different reasons including pain that wakes them up, stiffness which prevents comfortable sleeping posture, medications that are deleterious to sleep, and anxiety and stress related to their condition.

Better sleep is multi-faceted process including regular bed-time routine, cool, dark, quiet bedroom sleep environment, avoiding screens for at least one hour before bed, not drinking caffeine after 2 PM, and speaking to doctor if pain is interfering with your sleep.

Some people have also found mattress toppers helpful and supportive pillows to relieve sore or injured joints. Others find that a warm bath before bed helps with stiffness.

Stress Management: More Important Than You Think

Stress doesn't cause psoriatic arthritis. But it can make flares worse. Many people notice their symptoms get worse during stressful periods.

Stress management techniques that might help include deep breathing exercises, meditation (even 5-10 minutes daily), regular exercise (which also reduces stress), talking to a counselor or therapist, and connecting with other people who understand.

Support groups can be particularly helpful. You can find local groups through the National Psoriasis Foundation. Online communities are also available if you can't attend in-person meetings.

Research and Clinical Trials

For some patients, joining clinical trials offers access to cutting-edge treatments not yet available to everyone. Clinical trials also help advance psoriatic arthritis treatment for future patients.

When thinking about joining a clinical trial, it's important to understand the possible benefits and risks. This includes the possibility of getting dummy treatments. But trials are carefully designed to keep participants safe. They often give access to close watching and care that goes beyond what's available in regular practice.

How Clinical Trials Work

Clinical trials happen in phases. Each phase answers different questions about a new treatment.

Phase I trials test safety. They use small groups of people. The main goal is finding the right dose and identifying side effects. These trials are usually for people who have tried many other treatments already.

Phase II trials test effectiveness. They use larger groups of people. Half get the new treatment. Half get a placeholder (placebo) or standard treatment. Researchers compare how well each group does.

Phase III trials compare new treatments to current standard treatments. These trials use hundreds or thousands of people. If the new treatment works better than current ones, it might get approved by the FDA.

Finding Clinical Trials

Your rheumatologist might know about trials in your area. Academic medical centers often run more trials than community practices.

You can also search for trials yourself at ClinicalTrials.gov. This government website lists all trials happening in the United States. You can search by diagnosis and location.

The National Psoriasis Foundation also has a current list of psoriatic arthritis and psoriasis studies.

Questions to Ask About Clinical Studies

Before deciding to participate in a study, ask these important questions: What is the study trying to find out? What will I be treated with? What are the possible risks and benefits? How long will this study run for? What happens if the treatment is unsuccessful? What happens when the study is completed? Will I be allowed to continue the treatment, if it helps?

Recent New Discoveries

Research scientists are exploring some exciting new directions for psoriatic arthritis.

Precision medicine is closer than we realize. Researchers are identifying genetic markers that may help predict which patients will respond to which treatment. This may eliminate the stipulation of trial and error that we currently use.

There are many new potential drug targets. Researchers have identified new proteins associated with psoriatic arthritis; existing medicines do not target these proteins. By blocking these new pathways, it may be possible to assist people who do not respond and/or do not tolerate current treatment programs.

Combination therapy is being investigated in a systematic way. Instead of the current approach of randomly adding medications, researchers are systematically using combinations that attack different aspects of the immune system.

We continue to make strides in developing biosimilars. As the original biologics lose patent protection, additional biosimilars will continue to emerge. This adds competition; competition ultimately leads to cost for patients - if a comparable treatment option comes at less of a cost, at least we have options, and do not have to pay top dollar for it to be the original biologic agent.

The Economics of Psoriatic Arthritis

When thinking about the economics of a diagnosis of psoriatic arthritis, Keep in mind that the burden of finances extends beyond the costs of prescriptions. Additionally, when thinking about the costs of a diagnosis of psoriatic arthritis, keep in mind the total cost of the condition during the active diagnosis. You may be surprised about the cost burden that you will have, especially as you consider these in terms of making decisions about your treatment regimen.

Direct Medical Costs

Direct medical costs include all that you will pay for medical care directly related to psoriatic arthritis (limitations depend on your insurance plan). These include doctor appointments (rheumatologist, dermatologist, primary care), lab tests (every 3 - 6 months of blood work), imaging (X-ray, MRI if needed), prescriptions, physical therapy, and visits to the emergency department for flares.

For individuals with moderate to severe psoriatic arthritis, the direct medical costs usually exceed $20,000, and most of those costs are incurred due to biologics; however, the even 'cheaper' DMARDs costs add up significantly when factoring the required monitoring of tissue pathology and drugs changes.

Indirect Medical Costs

Indirect medical costs are hidden and difficult to measure, but are just as significant. These include missed work for appointments, income loss from decreased productivity when experiencing a flare, income loss due to taking disability or reducing retirement age, and time lost of family members, from paid to unpaid work to help you.

One study suggested that indirect costs, total more than direct medical costs for the majority of participants with psoriatic arthritis, and especially for people diagnosed during their most productive years and life stage.

Consider Longer Term Costs

Once you have a diagnosis of psoriatic arthritis, you understand that even when considering the variability in the control of your illness, it is chronic, and the reality of dealing with all of the management burden associated with your condition will last your life, potentially for the rest of your life.

Therefore, it is helpful to think about the overall financial picture and approaches for your care. Think about choosing a health plan with the best prescription drug coverage, getting the most of health savings accounts (HSAs), considering how your health plan will calculate potential out-of-pocket maximum exposures, carefully documenting and keeping records of all medical expenses for tax time at year-end, and planning for any potential decreased working capacity or disability.

Some people enjoy working with a financial planner with experience with chronic illness costs. They can help you plan for both expected and unexpected expenses.

Looking Forward with Hope

Psoriatic arthritis treatment in America has changed a lot over the past twenty years. The pace of new discoveries shows no signs of slowing. What was once a condition with few treatment options and poor long-term results has become much more manageable for most patients.

While challenges remain - especially around cost and access - the many good treatments now available means most people with psoriatic arthritis can get significant symptom control and keep good quality of life.

Sometimes the hardest part is working with knowledgeable and informed health care providers and finding out about treatment options and realistic but positive expectations.

Newly diagnosed patients might feel scared about what lays ahead, but remember that we are in a stage of treatment that has more options available to us and they have a higher success rate than they ever have.

A patient with 30 years of psoriatic arthritis- new treatment options are still a regular occurrence. These may offer better control or fewer side effects than current options.

The future of psoriatic arthritis treatment looks bright. Personalized medicine approaches, new treatment targets, and better delivery methods are all coming. While we work toward even better treatments, the medicines available today offer real hope. They can help control this complex condition. They can help you return to the activities and relationships that make life meaningful.

Living with psoriatic arthritis will likely always need some accommodation and ongoing medical management. But it no longer has to define the limits of what's possible in your life. With the right treatment approach and support team, the condition becomes something you manage rather than something that manages you.

You have more treatment options now than ever before. Work with your healthcare team to find what works best for you. Stay hopeful. Better days are ahead.