I’m not trying to be a difficult patient but every drug I’ve taken for my arthritis just doesn’t work. Either I get worse side effects than the arthritis symptoms or it simply doesn’t work. I have a special kind of arthritis called psoriatic arthritis. Is there anything new on the horizon for this problem?

Psoriatic arthritis is a type of joint disease that occurs in roughly less than 10 percent of people who have psoriasis. Usually a patient has psoriasis (the skin rash) for many years before the arthritis develops, and the arthritis comes on slowly. Patients with psoriatic arthritis must manage both the outbreaks of itchy, scaly skin and the pain and stiffness of arthritis.

One of the most commonly used medications for the treatment of psoriatic arthritis (PsA) are disease-modifying antirheumatic drugs (DMARDs). DMARDs not only control symptoms, they also slow the progression of disease. That’s what makes them “disease-modifying”.

The use of disease-modifying antirheumatic drugs (DMARDs) has changed the quality of life for many patients suffering from the effects of psoriatic arthritis. For those individuals who do not do well with these drugs, there aren’t very many other choices. But scientists point to a “therapeutic pipeline” of drugs that may be available in the near future.

Oral medications (pills taken by mouth) currently under investigation for the treatment of psoriatic arthritis include ustekinumab, apremilast, and tofacitinib. Each of these medications works in a slightly different way to regulate the immune system.

Ustekinumab (Stelara, Centocor) is a human monoclonal antibody. It is directed against two specific interleukins (interleukin 12 and 23). Interleukins are naturally occurring proteins that regulate the immune system and inflammatory disorders like rheumatoid arthritis. In Phase III trials for moderate-to-severe psoriasis, ustekinumab was safe and effective, especially for patients who failed to respond to other standard medications.

Apremilast works as an anti-inflammatory by suppressing more than one pro-inflammatory cells including, TNF-alpha, interleukins 6, 17 & 23, and interferon-gamma (among others). It is currently in Phase III clinical trials for the treatment of psoriasis, psoriatic arthritis, and other chronic inflammatory diseases. Early stage studies found this medication to be safe and well-tolerated with few side effects.

Tofacitinib inhibits Janus kinase, an enzyme that acts as a special signaling messenger in the immune system. Tofacitinib is currently in phase two trials with psoriasis and will be tested next with psoriatic arthritis. Tests are scheduled to run until January 2015. So it may be a while before we see this one on the market for psoriatic arthritis.