What Can Patients with Rheumatoid Arthritis Expect from Biologic Treatments?

Biologics are an advanced type of disease-modifying antirheumatic drugs (DMARDs) specifically designed to target various pathways in the immune response that leads to the inflammation and tissue damage seen in rheumatoid arthritis (RA). Unlike traditional DMARDs such as Plaquenil (hydroxychloroquine), Arava (leflunomide), and Otrexup (methotrexate), biologics are typically prescribed when one or more traditional DMARDs have not adequately controlled the disease.

Patients beginning biologic therapy for RA can expect a different mode of action as some biologics work by blocking the action of specific immune system proteins such as interleukin-1 (IL-1) or tumor necrosis factor-alpha (TNF-alpha). These proteins play significant roles in the inflammation and joint damage that characterize RA. For example, TNF-alpha is a key cytokine involved in the induction of other pro-inflammatory cytokines, activation of leukocytes, endothelial cells, synovial fibroblasts, suppression of regulatory T cells, and osteoclast activation.

Several biologics are available to treat RA, including:

Abatacept (Orencia)
Adalimumab (Humira)
Adalimumab-adaz (Hyrimoz)
Adalimumab-adbm (Cyltezo)
Adalimumab-afzb (Abrilada)
Adalimumab-atto (Amgevita), and more.

Combining a biologic with methotrexate has been found effective in treating RA for many individuals. Treatment options for RA may also include non-pharmacological strategies such as reducing joint stress through physical and occupational therapy and, in some cases, surgical intervention.

When starting biologics, it is essential to have realistic expectations regarding the timeline for improvement, the potential need for combination therapy, and the associated costs. Understanding these factors can help patients navigate their treatment journey more effectively.

In conclusion, biologics represent a significant advancement in the treatment of RA, providing relief for many patients where traditional medications have failed. With a variety of biologics available, tailored treatments targeting specific mechanisms in the pathogenesis of RA offer hope for better disease management and improved quality of life.