Do You Know the Source of Your Joint Pain?

Oftentimes, we consider wear and tear on our bodies to just be a natural part of life. A tweaked back here, a sore knee there—these kinds of aches, for most people, tend to go away on their own. But sometimes these episodes may be a sign that something else is going on.

In some people, aches and pains potentially could be associated with symptoms of an autoimmune disease called active psoriatic arthritis (PsA), a condition in which the body’s immune system attacks healthy cells and tissue, causing inflammation in the joints. Over time, if left untreated, this condition can progress and lead to joint damage, which can significantly interfere with daily activities. How can we recognize when these aches and pains are associated with active PsA and it is time to see a doctor?

Warning Signs to Look Out For

While not all aches and pains point to active PsA, it’s still important to listen to your body. “There are a lot of different symptoms of active psoriatic arthritis,” says Manish Jain, M.D., a practicing rheumatologist at Ravenswood Rheumatology in Chicago.* “Some people get joint pain, like in their knuckles, knees, and ankles; others feel tendon pain, like pain in the bottom of the foot; and others may feel symptoms of lower back pain or stiffness.” Here are some common characteristics to look out for:

Consider potential risk factors of active PsA. “One risk factor is having the skin condition psoriasis,” says Dr. Jain. “Up to 30 percent of people with the skin condition have joint inflammation, and could develop active psoriatic arthritis.”

If you don’t have psoriasis but there is a history of it in your family, you may also have an increased risk of developing active PsA. “In most patients, we see the skin symptoms first, but in 15 percent of people, the joint symptoms come first, with the skin symptoms showing up later,” says Dr. Jain.

At Risk or Experiencing Symptoms? What to Do Next

There is no blood test or x-ray that can diagnose PsA. That’s why Dr. Jain recommends that you tell your healthcare provider if you have any of the above symptoms and risk factors. Ask to be referred to a rheumatologist—a doctor who specializes in the management of chronic and progressive immune-mediated diseases like active PsA.

This is important because diagnosis and treatment are crucial with active PsA. “Sometimes patients don’t see a specialist, so symptoms can be overlooked or underestimated,” says Dr. Jain. This means it can take some time to get an accurate diagnosis and a treatment plan that can help. “This disease can be debilitating, it can cause joint pain, swelling and stiffness, and fatigue that can interfere with daily activities,” says Dr. Jain. “Treatment can help improve these symptoms of PsA.”

Once Diagnosed…

You and your rheumatologist can work together to create your personalized management plan once you have a confirmed diagnosis. “What works for one patient won’t necessarily be right for another, but that’s okay because there are many treatment options to choose from,” says Dr. Jain. “We recommend all patients do physical therapy and stretching exercises, and, if needed, lose weight, but patients may need medication as well. Thankfully, science has come a long way and we now have a number of medications that can help reduce the inflammation associated with active PsA.”

One class of medications that was proven safe and effective in clinical studies for patients living with active PsA is known as biologics. “A biologic is a treatment that targets specific pathways causing inflammation in active PsA,” says Dr. Jain. “When determining if a patient is a candidate for a biologic, I consider what other treatments they may have tried and I look to see which body parts are impacted by joint symptoms. I also look to see if skin disease is involved and take into account other psoriatic arthritis–related symptoms, like fatigue, that can help me better understand the patient’s condition,” says Dr. Jain. “One such biologic that I consider for my patients is TREMFYA^®(guselkumab).”

TREMFYA^® is a prescription medicine approved to treat adults with active psoriatic arthritis.

In two medical studies, more than half of patients treated with TREMFYA^® had at least a 20% improvement in joint pain, stiffness, and swelling at 24 weeks compared to placebo. Furthermore, at 24 weeks, people taking TREMFYA^® showed an overall improvement in their ability to perform daily activities such as getting dressed, eating and walking. Some patients also reported improvement in PsA-related fatigue as measured by the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F), a questionnaire to measure self-reported tiredness, weakness, and difficulty conducting usual activities due to fatigue. Individual results may vary.

Whether you’re just starting out on your treatment journey or have been doing trial-and-error for a while, Dr. Jain encourages you to stay hopeful. “Symptom relief is my goal for every patient,” he says. “Dealing with PsA can be challenging at times, but don’t get discouraged. Finding the right treatment can take time but it’s important to remember you have options.”

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about TREMFYA^®?

TREMFYA^® is a prescription medicine that may cause serious side effects, including:

Serious Allergic Reactions. Stop using TREMFYA^® and get emergency medical help right away if you develop any of the following symptoms of a serious allergic reaction:

• fainting, dizziness, feeling lightheaded (low blood pressure)
• swelling of your face, eyelids, lips, mouth, tongue or throat
• trouble breathing or throat tightness
• chest tightness
• skin rash, hives
• itching

Infections. TREMFYA^® may lower the ability of your immune system to fight infections and may increase your risk of infections. Your healthcare provider should check you for infections and tuberculosis (TB) before starting treatment with TREMFYA^® and may treat you for TB before you begin treatment with TREMFYA^® if you have a history of TB or have active TB. Your healthcare provider should watch you closely for signs and symptoms of TB during and after treatment with TREMFYA^®.

Tell your healthcare provider right away if you have an infection or have symptoms of an infection, including:

• fever, sweats, or chills
• muscle aches
• weight loss
• cough
• warm, red, or painful skin or sores on your body different from your psoriasis
• diarrhea or stomach pain
• shortness of breath
• blood in your phlegm (mucus)
• burning when you urinate or urinating more often than normal

Do not take TREMFYA^® if you have had a serious allergic reaction to guselkumab or any of the ingredients in TREMFYA^®.

Before using TREMFYA^®, tell your healthcare provider about all of your medical conditions, including if you:

• have any of the conditions or symptoms listed in the section “What is the most important information I should know about TREMFYA^®?”
• have an infection that does not go away or that keeps coming back.
• have TB or have been in close contact with someone with TB.
• have recently received or are scheduled to receive an immunization (vaccine). You should avoid receiving live vaccines during treatment with TREMFYA^®.
• are pregnant or plan to become pregnant. It is not known if TREMFYA^® can harm your unborn baby.
• are breastfeeding or plan to breastfeed. It is not known if TREMFYA^® passes into your breast milk.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

What are the possible side effects of TREMFYA^®?
TREMFYA^® may cause serious side effects. See “What is the most important information I should know about TREMFYA^®?”

The most common side effects of TREMFYA^® include: upper respiratory infections, headache, injection site reactions, joint pain (arthralgia), diarrhea, stomach flu (gastroenteritis), fungal skin infections, herpes simplex infections, and bronchitis.

These are not all the possible side effects of TREMFYA^®. Call your doctor for medical advice about side effects.

Use TREMFYA^® exactly as your healthcare provider tells you to use it.

Please read the full Prescribing Information, including Medication Guide for TREMFYA^®, and discuss any questions that you have with your doctor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
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* Dr. Manish Jain received an honorarium from Janssen compensating him for his time.

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