Treatments for Stubborn Rheumatoid Arthritis

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People who suffer from rheumatoid arthritis (RA) know all too well the aches, pains and creaky joints that are a part of daily life. This stubborn autoimmune disorder causes painful swelling, stiffness, and pain in the joints, and while there is no cure, there are treatments that can provide pain relief, slow progression of the disease, and improve your quality of life.

Initially, doctors tend to prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation, steroids to reduce pain and slow joint damage, or disease-modifying antirheumatic drugs (DMARDs) to slow the progression of RA and reduce joint and bone damage. But sometimes, these treatments aren’t enough to tackle severe RA. Between 30 and 70% of people who don’t benefit from other RA medications experience some relief from a new category of drugs called biologic response modifiers, or biologics.

What Are Biologics?

Biologics are genetically engineered from a living organism, such as a virus, gene or protein. They’re designed to prompt the body’s natural response to fight infection, inflammation and disease. Biologics target and block specific proteins, cells and pathways that cause the painful symptoms and damaging inflammation of rheumatoid arthritis.

Biologics are a newer class of DMARDs that includes abatacept (Orencia), anakinra (Kineret), adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi), infliximab (Remicade), rituximab (Rituxan), certolizumab (Cimzia), and tocilizumab (Actemra). These drugs are administered by injection or IV infusion. Also included under this classification is a synthetic DMARD taken orally called tofacitinib (Xeljanz).

Side Effects of Biologics

Minor side effects of biologics include abdominal pain, nausea, and injection site reactions. More serious side effects may result from immune system suppression. For example, some biologics have been shown to slightly increase the risk of patients developing serious infections. It’s natural to be concerned about the risk of a serious infection, so talk with your doctor about the risks regarding your unique health situation. He or she can help you determine if the risks from medication are worth the relief they’ll provide you.

Who Should Try Biologics?

Biologics are typically reserved for people whose arthritis has not responded well to conventional DMARDs.

Who Should Not Try Biologics?

Your doctor should  not prescribe a biologic if:

  • Your RA is not active

  • You haven’t tried a conventional DMARD first

  • You have an infection

  • You’ve reacted poorly to biologics in the past

Biologics may not be the best fit for you if:

  • You are pregnant or breastfeeding

  • You’ve had tuberculosis

  • You’ve had repeated infections

  • You have cancer, a serious heart condition, or lung fibrosis

If your doctor suggests biological therapy to help prevent rheumatoid arthritis symptoms from getting worse, he or she should make sure you’re up to date on your vaccinations and screen for latent tuberculosis before starting this medication. You should always talk with your doctor about medications you’re taking (even over-the-counter drugs) so together, you can make an informed decision about your treatment options.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Sep 20
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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  4. De Keyser F. Choice of Biologic Therapy for Patients with Rheumatoid Arthritis: The Infection Perspective. Curr Rheumatol Rev. 2011 Feb;7(1):77–87.