Is It Time to Step Up Your RA Treatment?

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If you’ve tried everything to treat your rheumatoid arthritis (RA) with little success, there may be hope just yet. There’s a newer class of drugs that have helped many people control their joint pain and preserve mobility over the past several years. These drugs, called biologic response modifiers (“biologics” for short), have been shown to slow the progression of RA when other treatments haven’t worked.

What are biologics, and how do they work?

Biologics target your immune system. But unlike traditional RA drugs that take a broader approach, biologics target specific components of your immune system that cause progressive joint damage and those debilitating arthritis symptoms. They are genetically engineered using human genes and are designed to “interrupt the system” specifically, the pathways that trigger inflammation. This helps relieve joint pain and prevent or slow tissue damage.

If you haven’t responded well to other drugs, such as methotrexate, talk to your doctor. Now may be a good time to review your treatment plan and see if a biologic is something that may work. Your doctor may prescribe biologics alone or along with other non-biologic drugs. Many people find a combination of medications is the best way to get lasting relief. One rationale for a adding biologics to your medication regimen is it may allow your rheumatologist to lower the doses of the traditional drugs you’re prescribed. Long-term use of certain traditional RA medications, like oral steroids, can have serious side effects.

Are they safe?

In general, biologics have fewer side effects than most traditional drugs used to treat RA. But there are some side effects, as well as risks, you should be aware of before you add them to your treatment plan.

Biologics are given by injection or intravenous infusion—an IV. You may find you have pain or a rash at the injection site. You may also find that you have headaches or some nausea—but the good news is, it doesn’t usually last.

The Potential Risks

Since biologics affect the way your immune system works, they also affect the way it responds to threats to the body. This can make you more prone to bacterial, viral and fungal infections, or those that affect the airways, such as tuberculosis.
The long-term effects of biologics are still unknown, but there has been some concern about their link to liver damage and certain types of cancer. Over time, this risk decreases, but talk to your doctor about any concerns you may have. Understanding all the risks, and knowing what to look for, will help you safely get the most out of your treatment. 

Before taking a biologic, be sure to tell your doctor if you’ve had an infection, fever or lung disease. Report any symptoms you may be having, even if they seem mild or minor, such as chills or a sore throat. It’s also a good idea to discuss any vaccinations you may be considering. Most are okay, but live vaccines may not be safe.

Some common signs of infection:

The Combined Approach

While biologics can be helpful, there are other equally important ways to help protect your joints, including occupational or physical therapy. A combined approach to treatment will give you the best results. If you have severe joint damage that you can’t control with medication or therapy, ask your doctor about other options. He or she may suggest surgery to get you the relief you need.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Sep 23

  1. Biologics Overview. Arthritis Foundation.

  2. Rheumatoid Arthritis. Mayo Clinic.

  3. Choice of Biologic Therapy for Patients with Rheumatoid Arthritis: The Infection Perspective. National Center for Biotechnology Information, National Institutes of Health.

  4. Biologic Treatments for Rheumatoid Arthritis. American College of Rheumatology.

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