Biologics for rheumatoid arthritis (RA) are generally quick-acting and effective, but their effectiveness and the time it takes to see results can vary. Many are FDA approved, including adalimumab, infliximab, and abatacept.
Rheumatoid arthritis (RA) can be a challenging and painful condition to manage. Biologics are one type of disease-modifying antirheumatic drugs (DMARDs) your doctor might prescribe to treat RA.
Biologics have been shown to effectively treat RA symptoms by targeting specific parts of your immune system. But they don’t come without side effects.
Current Food and Drug Administration (FDA) approved biologics fall into different drug classes that target different parts of your immune system.
| Drug class | Drug name |
|---|---|
| TNF-alpha inhibitor | adalimumab, certolizumab pegol, entanercept, golimumab, infliximab |
| IL-6 inhibitor | tocilizumab, sarilumab |
| CD20 depleting antibody | rituximab |
| CD80/86 costimulation inhibitor | abatacept |
| IL-1 inhibitor | anakinra |
Ask your doctor which biologic they recommend for you based on the severity of your condition and whether you’re managing other health conditions, too.
Some biologics are administered in pill form, while many others are administered intravenously in a:
- doctor’s office
- clinic
- hospital
- infusion center
During an infusion, which can take several hours, a healthcare professional will monitor you for signs of adverse reactions. They may encourage you to take an antihistamine beforehand to reduce your risk of reaction.
Your doctor might otherwise prescribe a biologic that you can self-inject. Several biologics are available in easy-to-use auto-injectors.
If your insurance plan doesn’t cover auto-injectors, ask your doctor about prefilled syringes. Alternatively, you might receive unfilled syringes and vials of medication.
Ask your doctor for tips on how to use these devices and for more information about your dosing schedule.
Biologics are generally a very effective therapy for treating RA, according to a 2022 research review. If your prescribed biologic works as intended, it may:
- reduce inflammation
- limit symptoms such as joint pain
- stop your condition from worsening
You can expect it to take about 3 to 6 weeks to start seeing initial improvement but know that it can take up to 3 months or longer for biologics to reach their full effect. Let your doctor know if you aren’t seeing improvements in your RA symptoms after this time.
There’s no way to know beforehand if a specific biologic will work for you. If one drug doesn’t work, your doctor might prescribe another.
Biologics for RA suppress parts of your immune system, which increases your risk of serious infections.
Mild injection site reactions are also common. You might develop redness, swelling, itching, or pain around an injection site. If your symptoms last longer than 5 days or you start to show signs of infection, contact your doctor.
Tell your doctor right away if you develop any of the following side effects after taking a biologic:
- skin, rash, hives, scaly patches, sores, or yellowing
- yellowing of your eyes
- easy bleeding or bruising
- vision changes
- changes to the appearance or volume of your urine
- discomfort or pressure when you urinate
- abdominal pain, nausea, vomiting, or diarrhea
- numbness, tingling, or weakness in your feet or hands
- sudden changes in your weight or appetite
- signs of infection, such as fever, chills, muscle aches, fatigue, persistent cough, or sore throat
Other adverse complications of biologics may include:
- increased risk of developing certain diseases, such as some cancers
- increased cholesterol, triglyceride, or liver enzyme levels
- false results in blood glucose readings
Many biologics aren’t recommended for people who are pregnant, nursing, or undergoing surgery. Tell your doctor immediately if you become pregnant while taking a biologic.
Speak with your doctor about your concerns and the possible risks of taking a biologic. In many cases, the benefits outweigh the risks.
If you develop any of the following symptoms within 24 hours of taking a biologic, contact emergency medical services (911):
- chest pain
- rapid heartbeat
- swelling of your lips, tongue, or throat
- wheezing or difficulty breathing
- dizziness or fainting
- rapid or weak pulse
- severe vomiting
You might need to undergo medical tests before, during, or after treatment with a biologic, including testing for:
- tuberculosis
- hepatitis B
- hepatitis C
- liver enzyme or liver function test
- complete blood count
- lipid panel (cholesterol)
- blood glucose test
- skin examination
These tests can help assess and manage your risk of the side effects discussed above and make sure you’re healthy enough to start or continue taking a biologic. Your doctor will have more information about testing.
Your doctor may prescribe a biologic to replace another medication you’re taking. Or, your doctor might add the biologic to your current treatment plan.
Taking multiple biologics at the same time may increase your risk of adverse side effects. A 2019 systematic review of 6 trials and data on more than 600 people with RA found that nearly 15% of people taking 2 biologics experienced a serious adverse event within a year.
Your doctor might encourage you to use a biologic along with other non-biologic treatments. For example, taking a biologic with:
- non-biologic DMARDs such as methotrexate
- nonsteroidal anti-inflammatory drugs such as ibuprofen
- corticosteroids such as prednisone
- occupational or physical therapy
- use of assistive devices or braces
- massage or other complementary therapies
- changes to your exercise routine, diet, sleep patterns, or stress management habits
- strategies to reduce your risk of infection
Ask your doctor about medications, supplements, herbal products, or vaccinations you should avoid while taking your prescribed biologic. Make sure to mention any other health conditions you might be managing, too.
Taking the right biologic can help reduce symptoms of RA and protect your joints from damage. But it’s important to take steps to prevent, recognize, and respond to potential adverse side effects.
Ask your doctor for more information about your prescribed biologic, including how it’s administered, when it will kick in, and how to limit and manage potential side effects.
You should also ask about how it will change your treatment plan for any other health conditions you might be managing.
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