In the last decade, there have been significant advances in treating rheumatoid arthritis, especially for patients whose arthritis does not respond to traditional disease-modifying antirheumatic drugs (DMARDs). The most important advance has been the development of a group of drugs called biologic response modifiers or biologics.

There are a number of biologics approved to treat rheumatoid arthritis. These include:

Enbrel
Humira
Remicade
Kineret
Rituxan
Orencia

Other biologics are being studied to treat rheumatoid arthritis as well as other forms of arthritis.

How Do Biologics Treat Rheumatoid Arthritis?

Biologics are genetically engineered proteins derived from human genes. They are designed to inhibit specific components of the immune system that play pivotal roles in fueling inflammation, which is a central feature of several forms of arthritis.

Biologics differ significantly from traditional drugs used to treat rheumatoid arthritis in that they target specific components of the immune system instead of broadly affecting many areas of the immune system.

What Are the Side Effects of Biologics?

As with any drugs that suppress the immune system, biologic therapy poses some increased risk of the body’s vulnerability to infections and other diseases. Patients taking biologics should seek immediate medical attention if they develop persistent fever or unexplained symptoms. Vaccinations that prevent infections should be considered prior to administration of biologics. Patients should not receive live vaccines while taking biologic medications.

Biologics may also cause some chronic diseases that are dormant (such as tuberculosis) to flare, and they are not recommended for people with multiple sclerosis and other conditions such as congestive heart failure. All patients should be skin tested for tuberculosis prior to starting biologics.

Since biologic therapy is in its early stages of use, some of the long-term effects of using these medications simply aren't known, and your doctor will want to regularly monitor your health while using them. Biologics are also more expensive than traditional treatments. However, the evidence so far is that they work well and can pose fewer risks than other systemic therapies.

One disadvantage to current biologic medications is that they must be given either by injection or by intravenous infusion.

Although animal studies of biologics have shown no effect on fertility or impairment of the fetus, these studies cannot always predict the effects in humans. Pregnant women should receive these drugs only if clearly needed because the effects on a developing child are unknown.

Biologics are commonly discontinued prior to surgery until wounds have sealed and infection risk has passed.

As a general rule, different biologic therapies should not be taken at the same time.

Researchers say that future biologics, still in the early development stages, may be less expensive and some will be taken orally. Also on the horizon are biologics that target different areas of the immune system, providing new treatment options.

Here are some details on available biologic drugs:

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Rheumatoid Arthritis Guide

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Diagnosis & Tests

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Finding Help

Do You Have Fibromyalgia Pain?

Cymbalta is approved for the management of fibromyalgia.

Important Safety Information

Cymbalta^® (duloxetine HCl) is approved for the treatment of depression and generalized anxiety disorder, and for the management of diabetic peripheral neuropathic pain and fibromyalgia.

What should I talk about with my healthcare provider?

Patients on antidepressants and their families or caregivers should watch for new or worsening depression symptoms, unusual changes in behavior, thoughts of suicide, anxiety, agitation, panic attacks, difficulty sleeping, irritability, hostility, aggressiveness, impulsivity, restlessness, or extreme hyperactivity. Call your healthcare provider right away if you have thoughts of suicide or if any of these symptoms are severe or occur suddenly. Be especially observant within the first few months of antidepressant treatment or whenever there is a change in dose.

You should also know that:

Suicide is a known risk of depression and some other psychiatric disorders.
Antidepressants may increase suicidal thoughts or behaviors in some children, adolescents, and young adults especially within the first few months of treatment or when changing the dose. No increased risk has been shown for adults over age 24, and risk decreased for those over age 65.
All patients starting therapy should be monitored appropriately and observed closely for new or worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
Cymbalta^® is not approved for use in patients under age 18.

Who should NOT take Cymbalta?
You should not take Cymbalta if:

You have recently taken a type of antidepressant called a monoamine oxidase inhibitor (MAOI)
You have uncontrolled narrow-angle glaucoma (an eye disease)
You are taking Mellaril^® (thioridazine)

What other important information should I discuss with my healthcare provider?
Before starting Cymbalta, tell your healthcare provider:

about all of your medical conditions, including kidney problems, glaucoma, or diabetes
about your alcohol use
if you are taking nonprescription or prescription medicines, including those for migraine, to address a possible life threatening condition
if you are taking NSAID pain relievers, aspirin, or blood thinners. Use with Cymbalta may increase bleeding risk
if you are pregnant, plan to become pregnant during therapy, or are breastfeeding an infant

While taking Cymbalta, tell your healthcare provider:

if you have itching, right upper belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of liver problems. Severe liver problems, sometimes fatal, have been reported
if you have high fever, confusion, and stiff muscles to address a possible life-threatening condition
before stopping Cymbalta or changing your dose
if you experience dizziness or fainting upon standing, especially when first starting Cymbalta or when increasing the dose. Your healthcare provider may periodically check your blood pressure while you are taking Cymbalta

If you have any questions, talk to your healthcare provider before taking Cymbalta.

What are the possible side effects of Cymbalta?

The most common side effect of Cymbalta was nausea. For most people who had it, the nausea was mild to moderate. Other common side effects included dry mouth, sleepiness, constipation, decreased appetite, and, increased sweating. This is not a complete list of side effects.

Safety Information and Boxed Warning | Prescribing Information | Medication Guide