Psoriatic arthritis condition guide · the spine, in addition to the skin and nail changes of psoriasis.1 There is no cure, but a number of medicines can help to manage symptoms

CONDITION GUIDE

Psoriatic arthritis

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Introduction and how to use this guide � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 1

Understanding PsA � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 3What is PsA? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 4Types of PsA � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5Who is affected? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5What are the symptoms? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 6What are the risk factors? � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 6

Taking care of your body � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 7Staying mobile with PsA � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 8Eating healthy � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 8Exercising regularly � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 9Sleeping well � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 9Maintaining a healthy weight � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 10Lifestyle approaches � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 11Supporting your emotional health � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 11

PsA treatment approaches � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13Staying on track with your medicines � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 14Treatment strategies and goals � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 14Medicines to treat PsA � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 15Administering your medicine � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18Injection-site reactions � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18Vaccine considerations � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19Complementary and alternative medicine � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19

Understanding side effects � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 20Possible side effects � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 21Nausea and diarrhea � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 22When it’s time to call your health care provider � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 22

Resources and References � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 24Resources � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 24References � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 26

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INTRODUCTION AND HOW TO USE THIS GUIDE

How to use this guideWe know the diagnosis of psoriatic arthritis (PsA) can be overwhelming. This guide can help answer concerns, while giving you important information to share with family or friends.

Your health care provider has prescribed drug treatment for your condition. This means that he or she believes you have a good chance of responding to medicine. We’re here to help, every step of the way. Remember that taking your medicine as prescribed will help you lead a healthy life. Please do not stop taking your medicine without checking with your health care provider.

Health care providers have learned how to individualize treatment so that each patient has the best chance of responding. The treatment you receive may differ from the treatment of other patients with PsA. This is one of the reasons it’s so important that you talk about any questions or concerns you may have with your health care provider or with a Prime Therapeutics Specialty Pharmacy™ (Prime Specialty Pharmacy) nurse or pharmacist.

Personal support can help make a challenging journey easier

24/7 ACCESS

Visit us online MyPrime.com/SpecialtyA pharmacist is always available to answer questions 877.627.6337 (TTY 711)

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INTRODUCTION AND HOW TO USE THIS GUIDE

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There are four parts to this guide

Understanding your PsA

We’re here to help you become a better informed member. In this chapter, we’ll discuss how to live your best life with a diagnosis of PsA.

2 Taking care of your body

Find ways to take charge of your health — both physically and mentally — with proactive approaches to your health.

3 PsA treatment approaches

Want to learn more about what treatment approaches that your health care provider or the Prime Specialty Pharmacy team might suggest? We’ll go over possible treatment plans, including medicine and other ways to help manage PsA in a way that works best for your lifestyle.

4 Understanding side effects

Learn when to call your health care provider and what tips can help reduce medicine side effects.

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Understanding your PsA

Did you know that approximately one million adults

in the United States (up to 20 percent of patients

with psoriasis) have PsA?1 Whether you’re newly

diagnosed or have been living with PsA for a

while, this guide is all about helping you become

better informed about PsA and your options for

staying healthy.

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UNDERSTANDING PsA

What is PsA?PsA is a chronic (long-term) condition involving the immune system. PsA causes swelling in any joint in the body including the spine, in addition to the skin and nail changes of psoriasis.1 There is no cure, but a number of medicines can help to manage symptoms. Treatment with these medicines, especially soon after diagnosis, can improve quality of life and overall health.

The immune system is the body’s defense against infection and disease. When the immune system detects cells that don’t belong in the body (bacteria, viruses or foreign cells), it releases cells to attack them. The immune system also helps the body to recover and heal after any illness.

In people with PsA, the immune system does not work properly. It attacks healthy cells as well as foreign cells. Immune system cells, known as T-cells, become overactive and attack the joints. This causes chronic inflammation, swelling and pain.

You are not aloneSymptoms vary from mild to severe in adults with PsA. Some individuals have mild or no symptoms (remission).2 One of the most important reasons for you to continue treatments, even if you feel fine, is that PsA can continue to affect your body over time.

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Types of PsAPeople with PsA have symptoms (swelling, stiffness and pain) in one or several joints at the same time. Some people show a blending of symptoms or have more than one type of PsA (for example, pain in both knees and inflammation of the spine).3

TYPE OF PSA BRIEF DESCRIPTION

Symmetric arthritis Affects about 50% of people with PsA

Symptoms are usually symmetrical, affecting the same joint on both sides of the body

Can appear similar to rheumatoid arthritis

Asymmetric arthritis Affects as many as 35% of people with PsA

Generally mild form of the disease

Symptoms are not symmetrical; they do not usually occur in the same joint on both sides of the body

Distal PsA Usually involves the joints closest to the nails in the fingers and toes

Generally includes changes in the nail such as pitting, white spots and lifting from nail bed

Spondylitis Inflammation of the spinal joints (vertebrae)

Commonly includes pain and stiffness of the neck and lower back

Arthritis mutilans Seen in about 5% of people with PsA

Mainly affects small joints of hands and feet

Is a severe form of the disease that may lead to deformities

Who is affected?

PsA affects men and women equally and usually develops in adulthood, between the ages of 30 to 50 years. It is more common in Caucasian populations and generally psoriasis precedes the arthritis.1 It can also appear in childhood, with the peak period of onset at ages 11–12 years in both genders.3

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UNDERSTANDING PsA

What are the symptoms?Usually, the signs and symptoms of psoriasis appear first, but this is not always the case. Psoriasis symptoms include thick patches of inflamed, scaly skin.1 The symptoms of PsA come and go over time and often worsen over the long term.4 A pattern of remission and relapse is common. A remission is a period of time with mild or no symptoms. A relapse is when symptoms occur after a period of low disease activity. Additionally, a flare (or flare-up) is when existing symptoms suddenly get worse.

Different people have varying symptoms. The severity of symptoms can also differ. For some people who develop PsA, the disease can be severe. It can even be disabling.

PsA is not contagious and cannot be spread from one individual to another.

In general, the signs and symptoms of PsA may include:1

→ Painful, swollen joints that may have redness and are warm to the touch

→ Swollen fingers and toes (dactylitis)

→ Painful feet, especially the back of the heel and the sole of the foot

→ Pain and stiffness in the neck and lower back

→ Reduced range of motion of the joints

→ Scaly spots on thickened, reddened skin

→ Nail changes, such as pitting or separation from the nail bed

→ General fatigue

→ Inflammation or infection of the eye

What are the risk factors? The biggest risk factor for developing PsA is having psoriasis.1 Patients who have psoriasis lesions on their nails are more at risk for developing PsA.4 Many people with this condition have a parent or a sibling with psoriasis or arthritis.1

Recent studies reported that if people with psoriasis are obese at age 18, they are more likely to develop arthritis and develop it earlier than people who were in the normal range of their body mass index (BMI). In addition, people with more severe skin disease were more likely to have joint disease as well.1

Other conditions associated with PsA are high blood pressure, high cholesterol, obesity, or diabetes.5 Inflammatory bowel disease, interstitial lung disease, osteoporosis and gout are also common in cases of PsA.2

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Taking care of your body

Getting regular physical activity, eating right and managing

stress can help you feel better each day. These changes can

also help you improve your psoriasis or PsA. This includes

lifestyle habits, a smart sleep schedule and a great support

network. Keep reading to find out more.

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TAKING CARE OF YOUR BODY

Staying mobile with PsAPsA can cause stiffness of your joints and a reduced range of motion with changes in mobility. This sometimes affects balance and coordination. For our bodies to stay in balance, we need our eyes, ears, brain, sense of body position and perceptions. Ask your health care provider if physical or occupational therapy would be appropriate for you.

Eating healthyMost people with PsA do not have specific dietary needs or restrictions, and there is no specific diet that can cure PsA. Some people may experience weight gain due to limitations on their mobility or side effects from certain medicines. The most important things are to eat healthy and maintain a healthy weight. A balanced diet includes plenty of fruits, vegetables and whole grains. It also limits salt, sugar, saturated fat and alcohol. It may include daily vitamins and minerals.

Invest the time to learn how to improve your diet. A registered dietitian nutritionist (RDN) can help you develop a personalized eating plan.

Good nutrition can:

→ Improve immune function

→ Reduce inflammation

→ Increase muscle strength

→ Increase energy

→ Stabilize mood

→ Manage fatigue

Here are some tips for safe and healthy eating:

→ Eat small meals or snacks every three to four hours instead of three large meals each day.

→ Do not eat raw or undercooked fish or shellfish.

→ Drink at least eight glasses of water, or clear caffeine-free fluids every day.

→ Limit alcohol.

→ Foods rich in omega-3 fatty acids, such as fish, may be helpful in reducing inflammation.6

→ Ask your health care provider if you would benefit from dietary supplements.

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Helping your family and friends understand PsATaking the time to educate family and friends about PsA can help alleviate their concerns or fears. Consider talking to your family, friends or loved ones about your lifestyle modification and treatment plans. Including those you care about can give them a more realistic view of your experience with PsA. You can explain to loved ones when you need help and when you prefer to be independent. Remember, you are not in this alone. Your support group may want to be more helpful than you realize.

Exercising regularlyRegular exercise is important for managing the symptoms of PsA. Strengthening and range of motion exercises are also helpful. Use of exercise can relieve pain, maintain flexibility and range of motion as well as manage your weight. Some prescribed medicines can cause you to feel tired, and exercising may boost your energy level. Remember to check with your health care provider before starting an exercise program. Exercise can be done at home or with the help of a physical or an occupational therapist.

Tips for exercising with PsA include the following:

→ Warm up (light stretching) before exercise to help reduce joint pain.

→ Use range of motion exercises such as stretching and curling your fingers, moving your ankle in circles or side to side, and gently moving your knee in different directions.

→ Participate, if able, in low-impact exercise and sports (swimming, walking and biking).

→ Use cold packs to numb the pain and heat packs to relax tense muscles and relieve pain.

→ Ask for special accommodations at school to help manage limitations (for example, a low-impact activity during gym class).

→ Find the balance between rest and activity; find time for extra rest when it seems necessary.

Sleeping wellYour body needs rest to heal and recharge, especially during treatment for PsA. One of the best things you can do for your body is to make sure you are getting eight or more hours of sleep each night. If your body is telling you that you’re tired and you are having trouble falling asleep, make sure to mention it to your health care provider.

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Maintaining a healthy weightA healthy weight is one that allows your body to function at its best. To find out if your weight is at a healthy level, you should know your BMI. An RDN can be helpful in calculating a healthy weight for you. Achieving a healthy weight may also help your symptoms and condition.

1 Choose healthy options to keep your body functioning at its best. A website like ChooseMyPlate.gov can help you choose better meals.

2 Listening to your body is an important step in maintaining a healthy weight. If you experience cravings or notice that you are drawn to certain foods, try and work them into your daily meal plan. Additionally, creating a meal plan that allows you to focus on your food with little distraction can help you feel satisfied and full.

3 Accountability partners can be a great way to keep your goals on track. It may seem hard to eat healthier or lose weight on your own. Pair up with a workout buddy or an accountability partner you can talk about challenges and share celebrations with.

4 Create weight loss goals that are sustainable and realistic. Discuss your weight goals with your health care provider. Seeking out an RDN may also help you to change habits blocking your path to success. In just as little as five minutes a day, you can be off to a great start!

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Lifestyle approachesThere are many lifestyle modifications that can be used to help manage symptoms, including the following:

→ Use devices to protect your joints (for example, jar openers); consult with a health care provider or physical therapist about other devices that may be helpful; use both hands in lifting heavy items and use your body to push open doors, rather than just your fingers.4

→ Schedule regular eye health care provider appointments to check your eye health.2 Apply heat for relief of stiff joints and tight muscles, and cold for inflamed joints. Hot baths or showers can also help.4

→ Protect your skin by regularly applying moisturizers such as lotions or creams; consult with your health care provider.2

Supporting your emotional healthSome people become overwhelmed with their diagnosis and the life adjustments they need to make. This is normal. Managing your stress and emotions and seeking help from friends, family or professionals are important aspects of staying healthy. Many members also benefit from in-person or online support groups.

Children who have PsA need ongoing support and they need to know their condition is not their fault.

Stress

Whether you are newly diagnosed or have been living with PsA for some time, at certain points of your treatment you may experience stress. Stress may make the challenges of life difficult to handle — especially when it comes to your body. Here are three great ways you can manage stress:

Write it down: Record your thoughts in a journal and read it through often. Celebrate daily successes and share opportunities and challenges to help your brain recognize the many sides of your life.

Take a break: When you’re in the midst of a particularly difficult moment, take a step back and take a deep breath. Even taking a small nap or watching something you enjoy on TV may help brighten your mood.

Find a support group: Every individual needs a healthy balance of people that are able to help in stressful situations. Keep phone numbers handy for family or friends you trust. Reach out to them as often as needed.

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Depression

Depression is not a character flaw or weakness. It’s a health problem that starts from a chemical imbalance in the brain. If you have thoughts of suicide or of harming yourself or others, call 911 or go to the emergency room.

A note on depressionEveryone feels sad now and then. Sometimes a deep sadness or loss of interest in activities you usually enjoy can actually be a medical illness called depression. Depression causes deep sadness or high anxiety around every day activities, and may make it hard to live your life the way you want.

If you think you may be depressed, talk with your health care provider. He or she may prescribe an antidepressant medicine to help with your symptoms. Please note that it may take several weeks to feel the full benefit of antidepressants. Your health care provider may also recommend counseling with a mental health professional. It can be helpful to speak to someone about the impact PsA has had on your life.

FOR SUPPORT

National Suicide Prevention Hotline 1�800�273�8255 TTY 1�800�799�4889

Crisis Textline Text “GO” to 741-741

National Psoriasis Foundation psoriasis�org 503�244�7404 or 800�723�9166

Arthritis Foundation Arthritis�org 1�844�571�HELP (Toll-free)

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) NIAMS�NIH�gov 301�495�4484 877�22�NIAMS (Toll-free)

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PsA treatment approaches

Taking an active role in your health care includes paying

careful attention to both symptoms and treatment.

It also means talking openly with your health care provider.

This part of the guide can help you:

Track your disease symptoms and medicine side effects

Understand more about how your condition might affect quality of life

Understand more about how to get the most from your medicine therapy

Write down questions or concerns to discuss with your health care provider

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PSA TREATMENT APPROACHES

Staying on track with your medicines Here is what you can do to help get good results from medicine therapy:

DO

→ Call your health care provider or pharmacist with any questions you may have about your medicines.

→ Educate yourself about your medicines for PsA, especially risks and warnings.

→ Keep a list of the names and prescribed amounts for each medicine you are taking.

→ Stick to the medicine schedule your health care provider has prescribed.

→ Add taking your medicines into your normal routine.

→ Check with your health care provider before starting any new medicines, including vitamins, supplements, herbal remedies, prescription medicines and over-the-counter products.

DON’T

→ Skip or change doses. By taking your medicine as prescribed, you will improve the chances for a positive treatment outcome.

Treatment strategies and goalsHealth care providers use several different approaches to treat PsA. Treatment approaches consist of medicines, lifestyle approaches such as the use of exercise and rarely, surgery. No medicine can cure PsA. Rather, medicines can slow the progression of PsA, reduce symptoms and improve your quality of life. Keep in mind that you can live a good quality of life with management of the disease.

The goals of treatment are to:

→ Relieve pain, swelling and stiffness1

→ Minimize or stop permanent damage to the joints1

→ Clear skin lesions in people who have psoriasis2

→ Slow the progression of the disease1

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Medicines to treat PsA Health care providers use different types of medicines to help manage symptoms of PsA. The choice depends on managing the symptoms and preventing spinal deformity.7

Corticosteroids9, 10

Health care providers prescribe corticosteroids for short periods to relieve joint swelling. They often are used to manage flares. Corticosteroids can also be used by patients who don’t respond to NSAIDs or who cannot take them because of other medical conditions.

DRUG NAME FORMS POSSIBLE SIDE EFFECTS IMPORTANT INFORMATION

cortisone

dexamethasone (Decadron)

hydrocortisone (Cortef)

methylprednisolone (Medrol)

prednisone

Oral tablet

Injection

Bruising

Weight gain

Fluid retention

Trouble sleeping

Cataracts from long-term use

Mood swings

Increased appetite

High blood sugar

High blood fat

Hardening of arteries

Osteoporosis from long-term use

Store at room temperature.

Take with food.

Monitor bone health while taking this medicine.

Do not stop these medicines abruptly.

Taper dose off over time with guidance from your health care provider.

Place all used syringes in a Sharps container. Never throw a syringe into a trash can.

This guide is updated annually. Additional drug information can be found on our website at MyPrime.com/Specialty.

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Biologic response modifiers (BRMs) medicines

The newest class of medicines is called biologic agents and is used when the other medicines have failed to provide relief of the symptoms of PsA. Tumor Necrosis Factor (TNF) blockers, including interleukin (IL) 17 and ILL 12 and 23 agents are effective in treating inflammation.

BRMs block the destructive effects of the immune system. BRMs slow disease progression. They can induce remission in some cases.

BRMs are given as injections just under the skin (subcutaneously) or in a vein (intravenous [IV] infusion). This class of medicines may help patients who have not responded well to other treatments or also have psoriatic arthritis. BRMs may be used in combination with other medicines.


adalimumab (Humira)

certolizumab pegol (Cimzia)

etanercept (Enbrel)

golimumab (Simponi)

infliximab (Remicade)

secukinumab (Cosentyx)

ustekinumab (Stelara)

Subcutaneous injection

IV (infliximab only)

Injection-site reactions

Headache

Upper respiratory tract infections

Tuberculosis (TB) and other serious infections

Heart failure

Certain types of cancer

Infusion-related reactions such as fever, chills (infliximab only)

Possibility of reversible posterios leukoencephalopathy syndrome (RPLS) (ustekinumab only)

Nausea

Increased blood pressure

Flu-like symptoms

Abnormal liver function tests

Contact your health care provider before receiving any vaccinations or allergy shots.

Contact your health care provider if you develop symptoms of a cold or flu (fever, sore throat, fatigue, etc.).

Store under refrigeration or according to package directions.

May increase the chance of developing certain types of cancer.

Have regular blood test to monitor immune function.

Place all used syringes in a Sharps container. Never throw a syringe into a trash can.


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Phosphodiesterase 4 Inhibitor (PDE4) medicines

Phosphodiesterase 4 Inhibitors (PDE4) treat PsA, and are enzymes that break down parts of the immune cells in your body. They can help decrease the amount of cells that stimulate inflammation.3


aprelimast (Otezla) Oral tablet Diarrhea

Nausea

Vomiting

Headache

Upper respiratory tract infections

Contact your health care provider if you develop depression, worsening of depression, suicidal thoughts or other mood changes.

Contact your health care provider if unexplained or significant weight loss occurs.

May interact with certain medicines such as rifampin and those used to treat seizures such as carbamazepine, phenobarbital, phenytoin.


A note on traveling with disease-modifying drugsHave a successful trip by taking time to plan how to travel with your medicines. For security reasons, you may need to show a pre-printed label from your pharmacy to bring the medicine on an airplane. Contact the airlines if you have questions. Please make sure to keep medicines away from heat and direct sunlight and leave room in your bag for an ice pack or insulation.

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Administering your medicineSome medicines for PsA are taken by mouth and others are given by injection under the skin or into a vein to help control the disease process. If you’re worried about giving yourself an injection, your health care provider, nurse or pharmacist can talk to you about any concerns. They’ll demonstrate how to inject your medicine properly and, in many cases, can provide a device that will help. Your health care provider may also prescribe phototherapy. This provides controlled exposure to natural or artificial ultraviolet light.

Injection-site reactionsWhen you inject a medicine, a reaction may occur at the injection site. Reactions may include:

→ Redness

→ Swelling

→ Rash

→ Itching

→ Stinging

→ Pain

→ Tingling

→ Discomfort

The following steps may help reduce or prevent these reactions:

STEP EXPLANATION

Preparation Make sure the medicine is at room temperature before injection. Applying ice to the site before and after injection may lessen injection-site reactions.

Method Ensure that you are using the correct injection method for your medicine.

Placement Rotate each new injection site at least 1 inch apart.

Avoid injecting into ares that are swollen, red or hard.

Record when and where you inject each time to help keep track.

Supplies Use a new needle for each injection.

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Vaccine considerationsMany of the medicines used to treat PsA may weaken your immune system. This lowers your body’s ability to fight infection. Because of this, you should be cautious of vaccines that contain a live virus (for example, FluMist). A live vaccine contains a small amount of a weakened virus. This kind of vaccine helps the body to develop immunity against a specific disease. For most people with healthy immune systems, these vaccines are safe and effective. For people with weakened immune systems, live vaccines may actually cause an infection. Before receiving any vaccines, be sure to let your health care provider know which medicines you are taking.

Complementary and alternative medicine (CAM)You may be curious about complementary medicine. This refers to treatments such as herbal treatments or acupuncture. While some people benefit from CAM, these treatments can also worsen your condition. Check with your health care provider before starting any new medicines, including vitamins, supplements, herbal remedies, prescription medicines and over-the-counter products.

The future is brightStudies on patients diagnosed with PsA are happening every day. While health care providers prefer not to use the word “cure” when talking about PsA, new treatments and clinical trials are ongoing to combat this disorder. With new and valuable studies continuing to help health care providers make progress with treating psoriasis, there is hope for the future. You never know when the next study will offer an incredible discovery. Remember that your body functions best with the right lifestyle choices, good communication with your health care provider and by taking your medicines as prescribed.

You can review the clinical trials that are in progress at ClinicalTrials.gov and searching “psoriatic arthritis.” You can decide if a clinical trial is right for you by talking with your health care provider or pharmacist.

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Understanding side effects

Some people don’t experience any discomfort from

their medicine for PsA. Others may struggle when

dealing with side effects. The medicine may affect

your mental health and your body as a whole.

Here are the most common side effects patients

sometimes face. Remember, if any side effects have

changed your overall quality of life, it’s time to talk

to your health care provider.

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Possible side effects

1 If headaches are becoming more regular, consider drinking more fluids — especially water. Some patients have also found that dark rooms or warm baths can alleviate some headache symptoms. Make sure to speak to your health care provider or a pharmacist at Prime Specialty Pharmacy about using an over-the-counter pain reliever.

2 Take precautions to prevent infections. Avoid crowds, public places or other people who have cold or flu symptoms when the chance is high that you may contact flu or a cold from someone else.

3 If you have a fever, make sure to drink plenty of fluids. It’s important you talk with your health care provider if you’re taking acetaminophen before or after your injections.

4 If you don’t have an appetite, consider eating smaller and more frequent meals. Taking a walk before and after meals may also help stimulate your appetite and aid digestion. Practice good self-care, indulge in a few of your favorite meals and try taking supplements or drinking meal replacement shakes to help provide the nutrition your body needs.

5 If you’re feeling tired due to your medicines, try yoga or exercise to boost your energy levels. Check with your health care provider before starting to exercise. Make sure to drink plenty of fluids and get eight hours of sleep a day. If you’re overweight, losing a few pounds can help restore your energy levels and combat fatigue.

ASK YOUR HEALTH CARE PROVIDER

If you have a symptom or side effect that worries you, it’s always best to call your health care provider� He or she will determine if you need immediate attention and the next steps to take�

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UNDERSTANDING SIDE EFFECTS

Nausea and diarrheaSome medicines may cause digestive issues including nausea and diarrhea. When either occur, it’s important you keep your body hydrated and well-rested. For nausea, consider taking small bites of a cracker or try eating foods at room temperature. For diarrhea, consider limiting foods that contain caffeine and taking dairy out of your diet. Also avoid foods that cause cramping, such as cabbage, beans, onions, green peppers and carbonated drinks.

When it’s time to call your health care providerChest pain

This includes discomfort in your chest, esophagus (throat) or lungs. This may feel like a burning or aching chest pain. Seek emergency treatment immediately if you develop chest pain while taking medicines for PsA, especially if the pain is:

→ Very severe

→ Different from pain you or your child have had before

→ Occurs when you are doing a strenuous activity, such as climbing stairs

Shortness of breath

If you feel short of breath, call your health care provider. He or she will determine if it’s related to your PsA medicines or if it’s another medical problem that requires prompt attention.

Vision changes

Although it is uncommon, some people have sudden changes in vision while taking their PsA medicine. Call your health care provider right away if you develop:

→ Blurry vision

→ Disturbance of color vision, sharpness or field of vision

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A note on pregnancy and breastfeeding Let your health care provider know if you’re pregnant or planning to become pregnant. Some medicines for psoriasis are not recommended for pregnant women or may pass into breast milk. Your health care provider may advise you to stop taking certain medicines during pregnancy or when breastfeeding your infant.

Also call your health care provider right away if you experience:

→ Swelling in your legs, feet or ankles

→ Severe diarrhea lasting for more than 48 hours

→ Blood in your stool

→ Skin rash or unusual skin reaction in the area of an injection

→ Body temperature higher than 100.5 at any time, or you have a fever lasting longer than 48 hours

→ Extreme fatigue

→ Allergic-type reactions such as trouble breathing, hives, etc.

→ The injection site does not heal within a few days

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RESOURCES

ResourcesORGANIZATION DESCRIPTION

American Academy of Dermatology aad.org 866.503.SKIN (7546)

The American Academy of Dermatology was founded in 1938. With a membership of more than 19,000, it represents virtually all practicing dermatologists in the United States, as well as a growing number of international dermatologists. Their mission is promoting leadership in dermatology and excellence in patient care through education, research and advocacy.

ClinicalTrials.gov clinicaltrials.gov

A database of publicly and privately supported clinical studies of human participants conducted around the world.

This is a service of the U.S. National Institutes of Health (NIH).

EatRight Academy of Nutrition and Dietetics eatright.org

National organization of food and nutrition professionals, who play a key role in treating persons with illnesses offering medical nutrition therapy in a variety of settings.

International Psoriasis Council psoriasiscouncil.org 972.861.0503

Founded in 2004, the International Psoriasis Council (IPC) is a dermatology-led, voluntary, global nonprofit organization dedicated to innovation across the full spectrum of psoriasis through research, education and patient care.

Mayo Clinic mayoclinic.com

The Mayo Clinic is a non-profit medical practice and medical research group based in Minnesota.

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ORGANIZATION DESCRIPTION

National Institute of Arthritis and Musculoskeletal and Skin Diseases niams.nih.gov Toll free: 877.22.NIAMS (877.226.4267) TTY: 301.565.2966

The National institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is part of the NIH. Its main function is to support research on arthritis and other related diseases. This site has a searchable database of information related to rheumatoid arthritis, including research studies.

National Psoriasis Foundation psoriasis.org 503.244.7404 800.723.9166

The National Psoriasis Foundation (NPF) is a non-profit organization with a mission to drive efforts to cure psoriatic disease and improve the lives of those affected.

Patient Advocate Foundation patientadvocate.org

Patient Advocate Foundation (PAF) is a national 501 (c) (3) non-profit organization which provides professional case management services to Americans with chronic, life threatening and debilitating illnesses.

U.S. National Library of Medicine nlm.nih.gov

The U.S. National Library of Medicine offers visitors online materials for reading on medical issues, disorders and treatments.

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References1. National Institutes of Health (NIH) Staff, “Psoriatic Arthritis Overview,” NIH National Institute

of Arthritis and Musculoskeletal and Skin Diseases, October 2014. [Online]. Available: http://www.niams.nih.gov/health_info/psoriatic_arthritis/default.asp. [Accessed 6 July 2016].

2. Arthritis Foundation National Office, “Psoriatic Arthritis,” Arthritis Foundation National Office, unknown. [Online]. Available: http://www.arthritis.org/about-arthritis/types/psoriatic-arthritis/. [Accessed 18 July 2016].

3. National Psoriasis Foundation, “About Psoriatic Arthritis,” National Psoriasis Foundation, 2016. [Online]. Available: https://www.psoriasis.org/about-psoriatic-arthritis. [Accessed 9 July 2016].

4. Mayo Clinic Staff, “Psoriatic Arthritis,” Mayo Clinic, 29 January 2014. [Online]. Available: http://www.mayoclinic.org/diseases-conditions/psoriatic-arthritis/basics/definition/con-20015006. [Accessed 7 July 2016].

5. P.M. a. A.Z.M. Emery, “Psoriatic Arthritis,” American College Of Rheumatology, September 2013. [Online]. Available: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Psoriatic-Arthritis. [Accessed 20 July 2016].

6. A. Simopoulos, “Omega-3 Fatty Acids in Inflammation and Autoimmune Diseases,” J Am Coll Nutr, vol. 6, pp. 495-505, 2002 Dec 21.

7. Mayo Clinic, “Ankylosing Spondylitis,” Mayo Clinic Foundation for Medical Education and Research, 11 February 2014. [Online]. Available: http://www.mayoclinic.org/diseases-conditions/ankylosing-spondylitis/basics/definition/con-20019766. [Accessed 13 June 2016].

8. “Diseases and Conditions”. The Cleveland Clinic Foundation. Accessed 10/15/2015. https://my.clevelandclinic.org/health/diseases_conditions/hic_arthritis.

9. “Corticosterioid Therapy.” Centers for Disease Control and Preventon. Accessed 10/15/2015. www.cdc.gov/ncbddd/dba/corticosteroid.html.

10. “Prednisone and Other Coricosteroids.” Mayo Clinic. Accessed 10/15/2015. www.mayoclinic.org/steroids/art-20045692.

REFERENCES

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NOTES

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NOTES

Prime Therapeutics Specialty Pharmacy LLC (Prime Specialty Pharmacy) is a wholly owned subsidiary of Prime Therapeutics LLC (Prime). Prime Specialty Pharmacy works with your health plan to provide the specialty medicines you need. Prime Specialty Pharmacy wants to help you get the most from your medicine therapy by:

→ Helping you get the medicines you need, when you need them

→ Providing ongoing, personalized support from disease-specific experts

→ Helping you manage the details so your condition does not manage you

→ This guide provides an overview of psoriatic arthritis� It is not meant to replace medical advice from your health care provider, pharmacist or other health care provider� Please contact them for more information� This guide is intended to be accurate� However, Prime Therapeutics and Prime Specialty Pharmacy are not responsible for loss or damage due to reliance on this guide�

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ABOUT PRIME THERAPEUTICS SPECIALTY PHARMACY

We are trusted by your health plan to help you get the medicine you need to feel better and live well. Our pharmacy experts are working hard to make your medicine more affordable, and your experience easier.

We are fully accredited by URAC — Specialty Pharmacy Accreditation and ACHC (Accreditation Commission for Healthcare) — Specialty Pharmacy Accreditation.

For more information on Prime Specialty Pharmacy, call 877.627.6337 (TTY 711) or visit us at MyPrime.com/Specialty.

All brand names are the property of their respective owners.

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Documents

Psoriatic arthritis condition guide · the spine, in addition to the skin and nail changes of psoriasis.1 There is no cure, but a number of medicines can help to manage symptoms