Jul 14, 2011 5:55 PM
Since they were first introduced in 1998, biologic response modifiers -- or biologics -- have made a huge difference in the lives of people with rheumatoid arthritis.
These powerful drugs don't just treat the symptoms of RA. Biologics for rheumatoid arthritis can target the underlying cause, relieving pain and saving the joints from damage.
"Biologics can have side effects, no question," says Eric L. Matteson, MD, chair of the rheumatology department at the Mayo Clinic in Rochester, Minn. "But in the long run they can help control the disease. That will lower your risk of surgery and allow you to keep working, live better, and live longer."
If you have RA, are biologics right for you? How can you make sense of their benefits and their risks? Here are things to consider about biologics for rheumatoid arthritis.
RA is an autoimmune disease. For reasons we don't understand, the body's immune system becomes too aggressive. It attacks healthy tissue in the joints and elsewhere in the body.
Biologics can't cure RA. They work by blocking the effects of the immune system, protecting the body from itself.
In the past, doctors could only treat the symptoms of RA. This usually meant painkillers, steroids, and multiple surgeries. Biologics -- and other disease-modifying antirheumatic drugs (DMARDs) -- have revolutionized the approach.
Rheumatologists now start with a DMARD as soon as a person is diagnosed with RA. The most commonly prescribed is methotrexate.
The faster a person gets this treatment, the sooner she can slow down or stop the damage to her joints. In most people who use them, biologics can push the disease into remission, relieving pain and stiffness.
"We're in a new era now," says Clifton Bingham, MD, associate director of the Johns Hopkins Arthritis Center in Baltimore. "Using biologics and other DMARDs, we're having much better outcomes and avoiding surgeries that used to be routine."
Methotrexate is usually the first drug that a person will try after getting diagnosed. Typically, biologics are reserved as the next step.
When might a rheumatologist turn to biologic therapy? Here are few reasons.
There are a number of biologics to choose from. They work in different ways. TNF-blockers target a chemical messenger that triggers swelling. Other biologics affect different molecules involved in the immune response.
It can take a few tries before finding the biologic that works best for you. Sometimes, a drug that used to work stops helping and a new one needs to be substituted.
While it can be disappointing when a drug doesn't work, take heart.
"Switching biologics is common," says Matteson. "In the vast majority of patients, we can find a medication strategy that gets the disease under control and keeps it that way."
Biologics and other DMARDs work by blocking attacks from the immune system. That's their drawback, too. By suppressing the immune system, you become more vulnerable to infection and other problems.
The exact side effects depend on the specific drug. Some biologics can cause:
Biologics are not safe for everyone. If you have a condition like multiple sclerosis, hepatitis, or heart failure, your doctor might not recommend biologics.
Whatever you do, don't manage side effects on your own without your doctor's help by skipping doses or cutting down the amount of medicine you get. That's a bad idea, Bingham says. It could allow your RA to worsen. It could also mislead your doctor into thinking your medicine isn't working.
When you have RA, it's important to be an informed and active patient. If your rheumatologist recommends a biologic, here are a few things to ask:
When you first get diagnosed with RA, you might have doubts about treatment. If you're only having mild joint pain right now, are the risks of biologics and other DMARDs worth it? Can't you wait and see how it goes?
But a wait-and-see approach can have serious consequences.
"We know what will happen if we don't treat someone with rheumatoid arthritis," says Bingham. "They will get worse." In some cases, the damage may become so severe that even surgery won't help.
Matteson compares RA to other chronic conditions like diabetes and high blood pressure. At first, they might not seem like a problem. But untreated, they can lead to serious disease and even early death.
While the side effects from biologics might look scary, Bingham points out that the risks of untreated RA go far beyond achy joints. They include debilitating pain, heart problems, infections, and cancer.
We still don't have a cure for RA. But biologics offer hope to people who once had no good options.
"Biologics and other DMARDs are more successful than anything we could have imagined 15 years ago," Bingham tells WebMD. "These treatments have reshaped the face of the disease."