6 Questions to Consider before Starting Biologics for Rheumatoid Arthritis

Patient Expert
Medically Reviewed

“I’d like to try you on a biologic.” Many people with rheumatoid arthritis (RA) hear those words from their rheumatologist, often followed by a sense of panic. These are really big drugs and there are scary stories about them. This post will separate truth from fiction on six frequently asked questions about Biologics.

1. I’ve heard that Biologics are really toxic and dangerous. Is that true?

The Biologics are a serious medication for a serious problem. As such, they do pack more of a punch then some of the lower-level disease modifying antirheumatic drugs (DMARDs). Biologics can bring you into remission from RA, but they also have the potential for some serious side effects. It’s important to note is that this is a possibility, not a certainty. Many people take Biologics with manageable side effects, or none at all.

Given the potential for some very serious side effects, why would anyone take these meds? This is where the serious problem enters the picture. If untreated, RA can have its own “side effects” on your body, damaging joints and internal organs. Until very recently, people with RA had significantly lower life expectancy than the general population because of the impact of the disease, especially on heart health. We are seeing some encouraging studies that indicate the Biologics are increasing life expectancy.

Weigh the pros and cons of taking the meds versus not taking the meds, and have some in-depth discussions with your rheumatologist.

2. Can’t I just take regular RA medications?

There are a number of other RA drugs. The DMARDs include medications like sulfasalazine, Plaquenil, Arava, and methotrexate. It is quite common to start treatment on one of these drugs, especially methotrexate, considered the gold standard of RA treatment. Many insurance companies require you to try these drugs before going on to Biologics.

If you’re nervous about trying Biologics, you may want to talk to your doctor about triple therapy. Some studies have shown that treating RA with a combination of methotrexate, Plaquenil, and sulfasalazine can be as effective as treatment with a biologic and methotrexate.

3. I’m confused — is it best to get infusion or injection?

Most Biologics are administered either by injection or infusion. Injections are usually self-administered —your doctor or nurse will teach you how — and done either by pre-filled syringes or an auto-injector pen. Infusions happen at the clinic or infusion center, where the biologic is given through an IV. Xeljanz is the latest medication released on the market and is an oral medication in the new class called targeted synthetic DMARDs. It is a pill that is taken once or twice a day. Targeted synthetic medications are similar to biologics in efficacy and side effects.

In the absence of any other factors, the choice of infusion and injection depends largely on what’s works best for you. Some people prefer the more frequent self-injections, which can be done quickly in the comfort of your home. Others prefer to go to an infusion center about once a month. Infusions can be somewhat more costly than injections.

4. How long before the Biologics start to work?

Response time varies. Some people have a quicker response, while it can take longer for others.

Enbrel is known for its potential for a quick response — some people start feeling better within days of the first shot. Xeljanz may start to work within three weeks or so. However, most Biologics can take up to three months, maybe a bit longer, to really kick in. You may start to feel the effects sooner, though, gradually getting more energy, less pain, and less stiffness in the morning. It can be quite exciting to feel a little bit better every day.

5. There are so many Biologics to choose from. Which one is best?

Again, this depends on you and your RA. The choice may also be influenced by your preference in terms of injection versus infusion, previous experience with other Biologics, other concomitant medical conditions, lifestyle factors, and your rheumatologist’s preference based on their research and experience with the responses of other patients.

6. What can I expect in terms of side effects?

The Biologics and targeted synthetic DMARDs are immunosuppressants, so one of the primary side effects is an increased risk of infection. Most of the time, infection risks can be managed by being a bit more careful around dirty public areas, using frequent hand washing, and staying away from people who are sick. Upper respiratory infections (sinus infections) are also a common experience.

To manage the risk of infection, it’s a good idea to get three vaccines: flu, pneumonia, and tetanus. As some of the Biologics can also increase your risk of getting shingles, it’s recommended that you get that vaccine prior to starting these drugs.

Other common side effects may include fatigue and feeling queasy on the day of your shot, as well as headaches, increased gas and other gastrointestinal side effects. Usually, these are quite manageable.

Before starting Biologics, talk to your doctor about signs and symptoms of more serious infection or other severe side effects. Although rare, they are a possibility. Being aware of what a serious side effect might look like will increase your chances of getting it treated before it causes major problems.

Do you have other questions about Biologics?

See more helpful articles:

How Do Biologics Treat RA?

Best Ways to Manage RA Treatment Side Effects

How RA Treatment Has Changed

Remission: an Interview with Dr. Yusuf Yazici