A Brief Guide to Understanding Rheumatoid Arthritis Biologics

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Understanding Rheumatoid Arthritis Biologics
Biologics are widely considered to be the most significant advancement made in the treatment of rheumatoid arthritis in recent years.

In fact, the Arthritis Foundation calls them game-changing drugs for RA patients. So what are biologics and how do they work to combat this progressive and often debilitating autoimmune disease? If you or a loved one has been diagnosed with RA, the following brief guide to understanding rheumatoid arthritis biologics will help fill you in on these and other important details related to treatment.

What Are Biologics?

Biologics are genetically-engineered drugs made from proteins. They work by blocking the activity of specific chemicals or cells that are involved in the body’s immune response. These cells are usually overactive in RA patients, attacking the body’s own tissues to cause the inflammation process at the root of RA symptoms.

TNF inhibitors, also called Anti-TNF drugs, were the first biologics developed and are generally the first prescribed to patients. They are often used in cases where RA has not responded to traditional disease-modifying antirheumatic drugs (DMARDs). TNF, or tumor necrosis factor, is a protein that acts as a chemical messenger in the immune system. Blocking its actions in the body via TNF inhibitors produces a number of biological effects that work to prevent or reduce RA symptoms. These drugs reduce the flow of inflammation-promoting white blood cells into joints affected by RA. TNF also aids in regulating other inflammatory chemicals within the body, so use of TNF inhibitors reduces the inflammatory actions of these proteins in affected joints. Slowing or blocking the actions TNF and associated inflammatory chemicals works to reduce swelling, redness and pain, thereby decreasing the risk of joint damage.

TNF inhibitors approved for the treatment of rheumatoid arthritis in the U.S. include:

  • Infliximab
  • Etanercept
  • Adalimumab
  • Golimumab

Newer biologics work to inhibit other specific inflammation-related factors in the immune system. In turn, they reduce RA symptoms and limit the damage those symptoms can cause to joints and other tissues. These include various cytokines, which are chemical messengers that aid in specific immune system functions, and certain immune system cells such as B and T lymphocytes. The newer biologic drugs are typically used in patients that have not responded to anti-TNF treatment.
Approved biologics that work to inhibit immune factors other than TNF include:

  • Rituximab
  • Anakinra
  • Tocilizumab
  • Abatacept

The newest class of drugs for the treatment of rheumatoid arthritis are JAK inhibitors.

What To Expect From Treatment

If your doctor feels that conventional RA drugs are not working well for you, biologics will likely be recommended. In most cases, TNF inhibitors are the first type of drug used in biologic treatment, and are often combined with traditional DMARDs. While a large percentage of patients respond well to anti-TNF drugs, they do not work for everyone.

If the first one you try does not help after three months of use, your doctor will likely try another TNF inhibitor. If the second drug also fails, moving on to a non-TNF biologic is generally the next step. Like TNF inhibitors, not every non-TNF biologic works for everyone, so several medication changes may be necessary to find the optimal treatment.

Side effects are possible with use of biologics. Most common are pain and/or rashes at injection sites. Since all biologics suppress the immune system, patients who use them may be at elevated risk for infections and other diseases. Your doctor will be able to explain the specific risks and benefits of the drug he or she is recommending for your treatment.