What to Do When PsA Treatment Doesn't Work or Stops Working

If a PsA treatment isn’t working, it’s time to make an appointment with your rheumatologist.

In some cases, PsA may not be the cause of new symptoms—for example, people with psoriatic arthritis are at a higher risk of osteoporosis.

Medically reviewed in September 2022

One of the most challenging aspects of treating psoriatic arthritis (PsA) can be finding a therapy that works.

PsA is a type of inflammatory arthritis that affects roughly 30 percent of people who have psoriasis. Like psoriasis, PsA is an immune-mediated disease—it occurs as a result of abnormal immune system activity. This activity triggers inflammation that damages healthy cells and tissues. With psoriasis, this causes skin lesions. With psoriatic arthritis, this causes stiff, inflamed, painful joints.

PsA requires treatment
Treatment can help slow the progression of the disease, prevent joint damage, and prevent complications, and there are many medications that can help achieve these treatment goals, including a variety of different disease-modifying antirheumatic drugs (DMARDs).

DMARDs act on the immune system, suppressing immune activity or blocking specific molecules that are part of the inflammatory process. Different DMARDs work in different ways, and some DMARDs can be used in combination with one another. For example, a person may take a traditional DMARD in combination with a biologic therapy (which is another category of DMARD). DMARDs can also be used in combination with other medications, such as NSAIDs (non-steroidal anti-inflammatory drugs).

Treatments will not always work
One of the most important concepts to understand if you are treating PsA—there is no single best treatment that works for every person at every time. Finding the right treatment can also take some trial and error.

Some people begin treatment with therapies like NSAIDs (non-steroidal anti-inflammatory drugs) or corticosteroids. Others begin taking biologic therapies and/or other DMARDs shortly after they are diagnosed with PsA.

In other words, different therapies work—and do not work—for different people. As a person living with PsA, it’s important to know the signs that a treatment isn’t working. These can include:

  • Symptoms are getting worse—or they aren’t getting any better.
  • You’re experiencing new symptoms.
  • You’re experiencing more frequent flares, more severe flares, or flares that last a longer time.
  • Symptoms are getting in the way of your normal life and activities.
  • Symptoms have reappeared after being in remission.
  • Tests and exams show high levels of disease activity or detect ADAs.

If a treatment isn’t working, your first step is to make an appointment with to your rheumatologist.

Why treatments don’t work
There are multiple factors that need to be considered when a treatment isn’t working. One is the length of time you’ve been using that treatment.

Depending on the therapy being used, it can take several months before you see a response to treatment. In some cases, you may need to give a treatment more time or adjust the medications you are taking.

You should also talk to your rheumatologist about any problems you’ve had following your treatment plan. To work well, therapies need to be used exactly as prescribed. If you have skipped or missed doses, for any reason, be honest.

Recent events and your overall health should also be a part of the discussion. Illness, injury, and stress can trigger flares. If you are overweight or obese, getting to a healthier weight may improve how well you respond to treatment.

Why treatments stop working
Sometimes a medication can work well for a period of time and then stop working well or stop working altogether. This can occur when the immune system begins making anti-drug antibodies that target the drug as it circulates through the body.

These antibodies prevent the drug from working. They can also increase the risk of side effects from treatment. This is more common in some medications than others and switching to a different medication can help in some cases.

In other cases, PsA may not even be the cause of new symptoms—having one condition that affects the joints does not mean a person is exempt from having another. For example, people with psoriatic arthritis are at a higher risk of osteoporosis and osteopenia. This is another reason why it’s important to work closely with your healthcare provider any time you experience a new symptom or a change in symptoms.

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UpToDate. Patient education: Disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (Beyond the Basics).
Arthritis Foundation. The First Medications for PsA.
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