Biologic basics: what to know for your rheumatoid arthritis

If you’re living with rheumatoid arthritis (RA), you know that it’s essential to get treatment that not only helps you manage pain, but also lessens joint damage. Sometimes, however, traditional RA medications aren’t enough.

Enter biologics, a class of drug that’s been used to treat RA symptoms since 1998. But, while biologics do offer some potentially big benefits for people who experience more severe joint pain and inflammation, they also come with risks.

What is a biologic?

Broadly speaking, the drugs used to halt the progress of RA fall into three categories: conventional synthetic disease-modifying antirheumatic drugs (DMARDs or csDMARDs), targeted synthetic drugs (tsDMARDs), and biologic DMARDs (bDMARDs). DMARDs, such as methotrexate, work by suppressing the whole immune system, while tsDMARDs target a specific part of it.

Biologic DMARDs, or biologics, are genetically engineered inside living cells and made to mimic the role of certain proteins in the body. They work by blocking specific parts of the immune system. Sometimes, people are prescribed biosimilars, which mimic biologic drugs. They are different medications, but almost identical.

Traditional DMARDs are typically the first choice for treating RA. Biologic medications are usually prescribed for people whose regular treatments and medication aren’t easing symptoms.

The most commonly prescribed, approved biologic treatments for RA are:

• Tumor necrosis factor-a (TNF) inhibitors, such as adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), and others
• B-cell inhibitors, such as belimumab (Benlysta) and rituximab (Rituxan)
• Interleukin inhibitors, including anakinra (Kineret), canakinumab (Ilaris), guselkumab (Tremfya), and others
• Selective co-stimulation modulators, of which there’s only one drug currently—abatacept (Orencia)

How do biologics treat rheumatoid arthritis symptoms?

Rheumatoid arthritis happens when your body’s immune cells mistakenly attack joint tissue, triggering inflammation and causing joint damage and pain.

Biologic drugs specifically target certain areas of the immune system that cause inflammation in the joints. Essentially, the drugs calm inflammatory proteins or cells, reducing inflammation and pain, potentially protecting those joints from further damage.

Biologics are often taken via self-injection or intravenous (IV) infusion. In most cases, they are used alongside nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, and glucocorticoids (GCs), like prednisone or hydrocortisone, to help treat and manage symptoms.

Are biologics safe?

While most patients report no severe or life-threatening side effects, this type of treatment does come with some risks.

Biologic medications are typically taken through an injection, so there’s a chance of infection at the injection site, along with a risk of swelling, pain, or rash. B-cell inhibitor infusions (given by IV) can also potentially cause issues such as blood pressure changes, trouble breathing, feelings of dizziness, and symptoms commonly associated with flu.

Since biologics work by suppressing part of the body’s immune system, they can increase your risk for various types of infections and cancers. Biologics can also cause certain conditions you may have or may have had in the past (such as tuberculosis and hepatitis B) to worsen or reactivate, so you should be tested for them before starting treatment.

Despite these risks, evidence suggests biologics don’t shorten lifespan when compared to other RA drugs. One 2022 meta-analysis published in the journal Medicine found that people with RA who took biologics had the same risk of dying as those who are treated with conventional DMARDs. People who used more TNF inhibitor biologics may have faced a slightly increased risk, but more studies are needed.

Will biologics help me manage my RA pain effectively?

Biologics can be very effective for people experiencing severe inflammation, who haven’t seen relief from traditional options. Research suggests they work better than traditional DMARDs at protecting the joints from damage caused by RA, and can help reduce fatigue, as well.

The medications affect each person differently, however, and it’s not possible to gauge the effectiveness of treatment until you’ve taken them for a number of weeks. (The time span will differ depending on the drug.) Sometimes a biologic drug will work well for one person but not another, or work well at first and then stop working. In cases like these, your healthcare provider (HCP) may prescribe you a different medication.

Are biologic drugs right for me?

Biologic treatments come with a higher price tag than traditional RA medication, costing upwards of five times more. However, their effectiveness means you may need fewer other treatments or appointments, which could bring associated healthcare costs down.

Many people who have tried other conventional medications with no result have seen big improvements in their symptoms when they added biologics to their treatment plan. It’s important to talk with your HCP. Discuss your symptoms and concerns openly so that you can decide on the most effective treatment for your RA pain.