From the Guidelines
Treatment of psoriatic arthritis in patients with hepatitis C should prioritize medications that minimize liver damage, with tumor necrosis factor (TNF) inhibitors like etanercept being a preferred first-line option due to their lack of hepatotoxicity and potential to improve viral outcomes, as supported by the 2018 American College of Rheumatology/National Psoriasis Foundation guideline for the treatment of psoriatic arthritis 1.
Key Considerations
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen or celecoxib can be used initially with regular liver function monitoring.
- Methotrexate should be avoided due to its hepatotoxicity, as highlighted in guidelines for the management of psoriasis and psoriatic arthritis 1.
- Ustekinumab, targeting IL-12/23 pathways, is another viable option.
- Coordination with hepatology is crucial before starting immunosuppressive therapy in patients with active hepatitis C infection.
- Antiviral treatment with direct-acting antivirals for hepatitis C should be considered concurrently with psoriatic arthritis treatment.
Treatment Approach
The approach should balance controlling joint inflammation with protecting liver function, considering the potential hepatotoxicity of conventional psoriatic arthritis medications, especially in patients with pre-existing liver disease. The most recent guidelines from 2019 emphasize the importance of evidence-based treatment recommendations for managing active psoriatic arthritis in adults, using both pharmacologic and nonpharmacologic therapies 1.
Adjunctive Measures
- Physical therapy
- Weight management These measures are important for overall patient care and can help mitigate the impact of psoriatic arthritis on quality of life. The 2018 guideline provides conditional recommendations for switching between different biologic therapies based on patient response and adverse effects, but prioritizes TNF inhibitors for their efficacy and safety profile in patients with hepatitis C 1.
From the FDA Drug Label
- 3 Psoriatic Arthritis HUMIRA is indicated for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis. HUMIRA can be used alone or in combination with non-biologic DMARDs.
The FDA drug label does not provide information on the treatment of psoriatic arthritis in patients with hepatitis C. Hepatitis C is not mentioned in the provided drug label for adalimumab (HUMIRA) in relation to psoriatic arthritis treatment.
- The label does discuss various indications, including psoriatic arthritis, but does not address the specific context of hepatitis C infection.
- It highlights the importance of considering the risks and benefits of treatment, especially in patients with chronic or recurrent infections.
- However, without direct information on hepatitis C, no conclusion can be drawn regarding the use of adalimumab in this specific patient population 2.
From the Research
Treatment Options for Psoriatic Arthritis in Hepatitis C Patients
- Etanercept therapy has been shown to be a safe and effective treatment option for patients with psoriatic arthritis and concomitant hepatitis C infection 3, 4, 5.
- Studies have demonstrated that etanercept can improve psoriasis and arthritis symptoms without worsening hepatitis C or interfering with hepatitis treatment 3, 4, 5.
- However, caution is advised when using etanercept in patients with concomitant alcoholic hepatitis, as it may lead to increased liver enzyme levels 5.
- Methotrexate, a commonly used disease-modifying anti-rheumatic drug (DMARD), may pose a higher risk of liver disease in patients with psoriatic arthritis compared to those with rheumatoid arthritis 6.
- Other treatment strategies for psoriatic arthritis include the use of non-steroidal anti-inflammatory drugs (NSAIDs) and classical DMARDs such as sulfasalazine, leflunomide, and ciclosporin 7.
Considerations for Hepatitis C Patients
- Close monitoring of viral load and hepatic enzymes is recommended when using etanercept or other treatments for psoriatic arthritis in patients with hepatitis C 3, 4, 5.
- Patients with psoriatic arthritis and concomitant hepatitis C infection should be carefully evaluated for the risk of liver disease when using methotrexate or other potentially hepatotoxic medications 6.
- Treatment strategies should be individualized based on the patient's specific condition, medical history, and potential risks and benefits of each treatment option.