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Biologics for RA: Understanding Risks and Benefits

What’s the Downside? Side Effects of Biologics

The most serious risk of taking biologics is infection. A suppressed immune system doesn’t go after viruses, bacteria, or other intruders as well. So people who take biologics are more susceptible to infections, including pneumonia and some food-borne illnesses. People with serious or active infections such as tuberculosis should not take biologics. Other precautions should be taken in those with heart failure or problems of the nervous system such as multiple sclerosis as biologics may exacerbate these conditions.

Injection site reactions can occur around the site where biologics are injected or infused. The area around injection sites sometimes become red, bruised, and painful, and you may need time off the biologic until the infection clears up. 

Infusion reactions can be more serious, causing chest pain, difficult breathing, and hives, among other things. For this reason, infusions are always done at a medical facility where they can be closely monitored.

A small number of biologics have the potential for more serious side effects. Some are only recommended when other biologics have failed.

Because each drug has its own set of potential side effects, you should talk about them with your doctor.

Biologics: Benefits vs. Risks

Unfortunately, every treatment carries risk, no matter what the condition. Patients and doctors need to weigh the side effects of available treatments against what could happen with no treatment. Though many people with RA experience periods of remission, the disease often becomes active again. 

Without treatment, RA reduces life quality and expectancy for most people. As RA progresses, it destroys cartilage and bone within the joint, then moves to the surrounding muscles, ligaments, and tendons.

For people with uncontrolled RA, fatigue, pain, and disability become a way of life. One study found a higher than normal rate of depression in people with RA, particularly those with poorly managed disease. People who had RA and who suffered from depression were more than twice as likely to die as RA patients without depression symptoms.

Chronic inflammation can damage other organs in the body as well. RA doubles the risk for heart disease. Approximately 30%-60% of people with RA develop anemia. In rare cases, RA can lead to tissue damage, nerve damage, and eye problems.

RA: Living With Uncertainty and Hope

As relative newcomers to the RA treatment scene, biologics come with many questions that have not yet been answered. For instance, what biologics work best for which person? Do biologics work better when used in combination with other drugs?

Though questions remain, biologics are part of a trend of significant improvements in RA treatment. The shift from “wait and see” to early, aggressive treatment has had a big impact on people’s lives. Review of a database of more than 3,000 people with RA found that the average level of disability has declined 40% since 1977 at a steady rate of about 2% each year.

“It’s better to have RA in 2010 than any time in the past thanks to advances in treatment,” Elena M. Massarotti, MD, at Brigham and Women’s Hospital Department of Rheumatology in Boston, tells WebMD. “I expect we’ll be even further along at this time next year.”

Reviewed on June 22, 2011

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