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Treating RA: Is It Time for a Biologic?

Biologics for RA: Things to Ask Your Doctor

When you have RA, it's important to be an informed and active patient. If your rheumatologist recommends a biologic, here are a few things to ask:

  • Why are you choosing this biologic medication? Doctors generally can't predict how well a medicine will work in a person. There's often some trial and error in settling on a drug. Still, it's good to ask why your doctor is choosing this medicine instead of another.
  • What other medicines will I need? A biologic is often used in combination with methotrexate. You might also need other medicines, like prednisone or painkillers. Doctors generally don't use two biologics for rheumatoid arthritis together. Why? They increase the risks without seeming to increase the benefit.
  • Will I receive it by injection or intravenously? Some biologics are only available intravenously at the doctor's office. Others can be injected at home.
  • How often will I need it? The dosage schedules vary widely. They range from twice a week to once every eight weeks.
  • Is the biologic therapy you're prescribing covered by my insurance? Biologics are expensive drugs. Insurance companies differ in which drugs they cover and when they will cover them.
    Matteson says it's not uncommon for a person's treatment to be guided by an insurance company's policies as much as the doctor's recommendations. Some people run into problems when changing jobs. A treatment covered by their old insurer might not be covered by a new one. Talk directly about the costs with your doctor, Bingham says.
  • What will my co-pay be? Even the co-pays for biologics can be expensive. Make sure you know if you have to pay a separate co-pay for the injection or infusion as well.
  • Am I eligible for financial assistance from the drug manufacturer? Many drug companies offer programs to help people pay for biologics.
  • What should I do if I have side effects? You need to know when to get help. Worsening symptoms, a fever, or weight loss are all signs that you should get checked out right away.
  • How often will I need checkups? At first, you will probably need to see your doctor every four weeks. If your treatment is helping and your disease is well controlled, you might only need checkups every three to six months, Matteson says.

Biologics: Weighing the Benefits and Risks

When you first get diagnosed with RA, you might have doubts about treatment. If you're only having mild joint pain right now, are the risks of biologics and other DMARDs worth it? Can't you wait and see how it goes?

But a wait-and-see approach can have serious consequences.

"We know what will happen if we don't treat someone with rheumatoid arthritis," says Bingham. "They will get worse." In some cases, the damage may become so severe that even surgery won't help.

Matteson compares RA to other chronic conditions like diabetes and high blood pressure. At first, they might not seem like a problem. But untreated, they can lead to serious disease and even early death.

While the side effects from biologics might look scary, Bingham points out that the risks of untreated RA go far beyond achy joints. They include debilitating pain, heart problems, infections, and cancer.

We still don't have a cure for RA. But biologics offer hope to people who once had no good options.

"Biologics and other DMARDs are more successful than anything we could have imagined 15 years ago," Bingham tells WebMD. "These treatments have reshaped the face of the disease."

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Reviewed on June 27, 2011

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