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Biologics for RA: Understanding Risks and Benefits

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RA Treatment Revolution

“Biologics have elevated the goals of treatment,” says Arthur Kavanaugh, MD, professor of clinical medicine in the Rheumatology Division at the University of California, San Diego. “We’re treating the disease earlier and more aggressively with much higher expectations for patient outcomes.” 

Researchers now recognize that the first year is a critical time to treat RA. Often much of the bone and joint damage occurs early, within a few weeks of onset. Biologics do not reverse existing damage, but can protect the joints against continued damage and have been shown to slow the progression of the disease. They are considered a possible treatment for patients who have uncontrolled RA despite the use of DMARDs.

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. 

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