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Treating RA: Is It Time for a Biologic?

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Since they were first introduced in 1998, biologic response modifiers -- or biologics -- have made a huge difference in the lives of people with rheumatoid arthritis.

These powerful drugs don't just treat the symptoms of RA. Biologics for rheumatoid arthritis can target the underlying cause, relieving pain and saving the joints from damage.

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"Biologics can have side effects, no question," says Eric L. Matteson, MD, chair of the rheumatology department at the Mayo Clinic in Rochester, Minn. "But in the long run they can help control the disease. That will lower your risk of surgery and allow you to keep working, live better, and live longer."

If you have RA, are biologics right for you? How can you make sense of their benefits and their risks? Here are things to consider about biologics for rheumatoid arthritis.

How Do Biologics for RA Help?

RA is an autoimmune disease. For reasons we don't understand, the body's immune system becomes too aggressive. It attacks healthy tissue in the joints and elsewhere in the body.

Biologics can't cure RA. They work by blocking the effects of the immune system, protecting the body from itself.

In the past, doctors could only treat the symptoms of RA. This usually meant painkillers, steroids, and multiple surgeries. Biologics -- and other disease-modifying antirheumatic drugs (DMARDs) -- have revolutionized the approach.

Rheumatologists now start with a DMARD as soon as a person is diagnosed with RA. The most commonly prescribed is methotrexate.

The faster a person gets this treatment, the sooner she can slow down or stop the damage to her joints. In most people who use them, biologics can push the disease into remission, relieving pain and stiffness.

"We're in a new era now," says Clifton Bingham, MD, associate director of the Johns Hopkins Arthritis Center in Baltimore. "Using biologics and other DMARDs, we're having much better outcomes and avoiding surgeries that used to be routine."

Who Needs Biologics for RA?

Methotrexate is usually the first drug that a person will try after getting diagnosed. Typically, biologics are reserved as the next step.

When might a rheumatologist turn to biologic therapy? Here are few reasons.

  • Treatment with methotrexate alone isn't working well enough. This is the most common reason for taking biologics. Your doctor will regularly examine your joints and test your blood for signs of RA. If methotrexate isn't helping enough, he or she might add a biologic. Studies suggest that the combination of drugs is more powerful than either on their own.
  • You have side effects from methotrexate. Some people don't tolerate methotrexate well. Some health conditions -- like liver problems -- rule out the use of methotrexate. In these cases, a rheumatologist might move directly to a biologic.
  • You are pregnant or want to become pregnant. Women with RA should talk to their doctors if they're considering pregnancy. Evidence suggests that some -- not all -- biologics might be safer for pregnant women than methotrexate. However, biologics can pose risks as well.
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