Yes, Skyrizi (risankizumab) is FDA-approved for the treatment of active psoriatic arthritis. The approval came on January 21, 2022, expanding the drug’s use beyond its original indication for plaque psoriasis. It can be used alone or in combination with a conventional disease-modifying drug like methotrexate.
How Skyrizi Works for Joint Disease
Skyrizi belongs to a class of biologics called IL-23 inhibitors. IL-23 is a protein that plays a central role in driving the inflammatory process behind both psoriasis and psoriatic arthritis. By binding to a specific part of IL-23 called the p19 subunit, Skyrizi blocks this protein from triggering the immune cascade that leads to joint pain, swelling, and skin plaques.
This targeted approach means Skyrizi doesn’t suppress the immune system as broadly as older treatments. It zeroes in on one specific inflammatory pathway rather than dampening immune function across the board.
How Well It Works
Skyrizi’s approval was based on two large clinical trials called KEEPsAKE 1 and KEEPsAKE 2. These studies measured improvement using a standard called ACR20, which represents at least a 20% reduction in joint tenderness, swelling, and other disease markers. Patients in both trials showed significantly better responses than those receiving a placebo at 24 weeks.
Long-term data from these same trials, tracked out to nearly four years (196 weeks), showed durable results. Among patients who responded well at 24 weeks, roughly 71% to 86% maintained that level of improvement through the full follow-up period. Similar patterns held for deeper levels of response (ACR50 and ACR70), meaning many patients continued to see meaningful joint improvement over years of treatment.
One area where Skyrizi’s track record is less clear is structural joint damage. In the KEEPsAKE 1 trial, 92.4% of patients on Skyrizi showed no radiographic progression at 24 weeks compared to 87.7% on placebo, but the difference between the two groups was not statistically significant. A VA pharmacy review noted that short-term Skyrizi therapy was ineffective at preventing the progression of bone erosions, and longer studies are needed. This is worth keeping in mind if you have erosive disease, as some other biologics have stronger evidence in this area.
Dosing Schedule
For psoriatic arthritis, Skyrizi is given as a 150 mg subcutaneous injection. You receive the first dose at week zero, a second dose at week four, and then one injection every 12 weeks after that. The every-three-month maintenance schedule is one of the least frequent dosing intervals among biologic options for psoriatic arthritis, which many patients find convenient.
Common Side Effects
The most frequently reported side effects include upper respiratory infections (such as sinus infections, sore throats, and common colds), headache, fatigue, and injection site reactions like redness or bruising. Fungal skin infections, particularly athlete’s foot and related tinea infections, also occur in some patients.
Less common but notable effects include abdominal pain, back pain, joint pain, and anemia. About 24% of patients in clinical studies developed antibodies against the drug, though this doesn’t always translate into reduced effectiveness or side effects. Because Skyrizi partially suppresses immune function, serious infections like cellulitis, shingles, and sepsis have been reported, though these are uncommon. Your doctor will check for tuberculosis before starting treatment, and you should avoid live vaccines while on the medication.
Where It Fits Among Treatment Options
European treatment guidelines from 2023 recommend starting a biologic after at least one conventional medication (like methotrexate or sulfasalazine) hasn’t worked well enough. No single biologic class is ranked above another for joint symptoms alone, since none has proven superior to the others for joint disease specifically.
Where IL-23 inhibitors like Skyrizi stand out is when skin involvement is significant. Head-to-head trials in psoriasis have shown that drugs targeting the IL-23 and IL-17 pathways clear skin more effectively than older biologics like TNF inhibitors. So if your psoriatic arthritis comes with substantial skin disease, Skyrizi may offer a two-for-one benefit. It’s also approved for Crohn’s disease, making it a logical choice for the 2% to 4% of psoriatic arthritis patients who also have inflammatory bowel disease.
Cost and Patient Support
Skyrizi is expensive without insurance, as is typical for biologics. For patients with commercial insurance, AbbVie offers a co-pay assistance program through Skyrizi Complete with a maximum annual benefit of $14,000. This program is not available to anyone on government-funded insurance, including Medicare, Medicaid, TRICARE, or VA programs. If your insurance plan uses an accumulator adjustment or co-pay maximizer program, the available assistance may be capped at $4,000 instead.