For many people with psoriasis, the skin is only part of the story. Joint pain, stiffness and swelling can come along with it, and managing both often means juggling more than one treatment plan. Now a biologic long used for skin has been cleared for the joints, too.
As reported by Dermatology Times, the FDA has approved ILUMYA (tildrakizumab-asmn), already used for moderate-to-severe plaque psoriasis, for adults with active psoriatic arthritis (PsA). PsA is a chronic inflammatory disease. It can affect joints throughout the body, including the spine, as well as the fingers and toes, the spots where tendons and ligaments attach to bone, and the skin. Without the right treatment, ongoing inflammation can lead to permanent joint damage and disability.
Why This Matters If You Have Psoriasis
About 2.4 million people in the U.S. are living with PsA, according to ILUMYA’s manufacturer, Sun Pharma. An estimated one in three people with psoriasis will develop it, and more than 15 percent of people with psoriasis may have PsA that hasn’t been diagnosed.
The approval also adds to ILUMYA’s list of uses. The FDA first approved it in 2018 for adults with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy. Its label expanded to include scalp psoriasis in 2024 and nail psoriasis in 2025.
What the Research Shows
The approval is based on two late-stage trials, INSPIRE-1 and INSPIRE-2, in adults with active PsA. Both tracked how many patients saw at least a 20-percent improvement in their joint symptoms by week 24.
- In INSPIRE-1, 61 percent of patients taking ILUMYA reached that mark, compared with 35 percent of those on placebo.
- In INSPIRE-2, the numbers were 64 percent and 33 percent.
Improvements showed up as early as week 8 and continued through week 24. The drug also improved other measures of disease activity. These included inflammation where tendons attach to bone (enthesitis) and swelling of entire fingers and toes (dactylitis).
ILUMYA is given as a 100-mg injection by a health care provider. Patients get two starter doses four weeks apart, then one dose every 12 weeks. ILUMYA blocks IL-23, a protein that drives inflammation in psoriasis and PsA. According to the company, it’s the only IL-23 inhibitor for PsA that’s administered exclusively by a provider.
Safety in the trials was consistent with what’s been seen in plaque psoriasis, with no new safety signals. ILUMYA may increase the risk of infection, so patients should be checked for tuberculosis before starting treatment. The most common side effects, seen in at least 3 percent of PsA patients, were upper respiratory infections and COVID-19.
What Doctors Want You to Know
“Psoriatic arthritis is a complex and chronic disease. As clinicians, we need a range of therapeutic options that allow us to individualize care based on each patient’s symptoms and treatment goals,” Seattle rheumatologist Philip Mease, MD, said in a statement. Dr. Mease is director of rheumatology research at Swedish Medical Center and Providence St Joseph Health and a clinical professor at the University of Washington School of Medicine. He added that a provider-administered IL-23 inhibitor gives appropriate patients another option while allowing more engagement with their health care team.
Christopher Bunick, MD, PhD, editor in chief of Dermatology Times, noted that evaluating and managing PsA is an integral part of dermatology care for people with psoriasis. He said the approval expands the targeted therapies dermatologists can use for patients with significant joint involvement. “The goal should always be to protect and/or treat joints in our psoriasis patients,” he said.
What This Means for You
Early joint symptoms are easy to chalk up to a tough workout or a bad night’s sleep. If you have psoriasis, it’s worth mentioning any stiffness or swelling at your next dermatologist appointment. This approval gives patients and their dermatologists one more way to treat skin and joints together.
