A Beginner's Guide to RA: Biologics
This last post about rheumatoid arthritis (RA) medications focuses on Biologics. Previously, I've covered NSAIDs, which treat symptoms of inflammation and pain, and non-biologic DMARDs, medications that treat the RA itself.
RA is a systemic illness, which affects not just your joints, but also other systems in your body, including the vascular systems and internal organs, such as the heart. At this time, there is no cure for RA. It is, however, possible to suppress the disease, slowing down or even stopping it from progressing and damaging the systems in your body.
What are Biologics?
Biologics are a class of medications designed to treat RA. They are genetically engineered proteins that are made from live cells. They target specific substances involved in the inflammatory response, such as cells (B-cell lymphocytes or T-calls) and proteins (TNF alpha, interleukin 6). Biologics used to treat RA can also be used to treat other autoimmune diseases, such as psoriatic arthritis, multiple sclerosis, and Crohn's.
Biologics were first introduced in 1999 when Enbrel came on the market. It was quickly followed by several others, such as Humira, Remicade, Cimzia, Simponi, and several others. At present, there are about a dozen on the market and many more in development. Most Biologics are administered by injection or IV infusion.
What are targeted-synthetic DMARDs?
Similar to biologics, a new class of medications called targeted synthetic DMARDS (tsDMARDs) are used to treat Rheumatoid Arthritis. Xeljanz is the only targeted synthetic DMARD currently available in the United States is a pill taken once or twice a day. Targeted synthetic DMARDs are similar to Biologics in efficacy.
Why take Biologics or targeted-synthetic DMARDs?
Biologics and targeted-synthetic DMARDs were a revolution in RA treatment. They have caused a change, not only in the rates of control of RA, but also in how it is treated. Biologic and targeted-synthetic DMARDs are very effective in treating RA, leading to a significant amount of people with RA achieving remission or low disease activity.
Because it is now possible to suppress the disease itself, the approach to treatment has changed. From the past "go low and go slow," which usually fails to control the disease, resulting in damage to joints and other systems, treatment is now early and aggressive, following the "treat to target" approach.
Treating to target involves adjusting medication every three months or so until remission has been achieved. Rates of remission vary depending on the measurement used. The new ACR/EULAR criteria are very stringent, leading to an only six percent remission rate. Before you panic, be aware that these criteria were intended for the evaluation of clinical trials. Measurements used in clinical practice are more flexible and the best rates of remission currently achievable are 40-50 percent. For many more individuals, low disease activity is also possible.
Biologics have also led to a significant change in another area of RA. Because of systemic inflammation, people with RA have a higher risk of heart attack and stroke. In the past, this led to a mortality gap: having a 10 years lower life expectancy than the general population. Since the introduction of Biologics, studies have demonstrated that the mortality gap has been reduced as lower levels of disease activity positively impacts heart health. This emphasizes the importance of treating RA aggressively to protect not only the joints, but also the rest of the body.
In addition to making an incredible change in the medical aspects of RA, Biologics have also caused a revolution in the quality of life experienced by people with RA. Many more people than ever before are living almost normal lives, continuing to participate in their families, work and communities.
Unfortunately, Biologics are very expensive, which can affect your ability to use them. However, there are a number of financial assistance programs for medication that can help you access the medication you need.
Common side effects and how to manage them
Biologics and targeted-synthetic DMARDs are immunosuppressants, which means that they will make you more vulnerable to infection. It is quite likely that if you're taking a biologic medications, you will be more susceptible to catching contagious illnesses and they may hit you harder. For most people, the risk of infection can be managed by being extra careful to avoid people in contagious stages of illness whenever possible, as well as taking extra care to avoid contamination around the home and in public. Getting the flu, pneumonia, and tetanus vaccine can also help protect you.
One of the most common infections experienced by people take Biologics is upper respiratory tract infections or sinus infections. You can managing this risk by using a saline solution or a Neti pot to rinse out the sinuses and reduce the risk of infection.
The Biologics and targeted-synthetic DMARDs are a serious medication for a serious problem. This means that they do come with the potential for more serious side effects than some other medications. Do take an illness or infection seriously and talk to your doctor about signs that you should be seeking urgent medical help. It is important to remember that these types of side effects are rare, so there's no need to be anxious.
What has been your experience taking Biologics for your RA?