When you start taking a biologic drug for rheumatoid arthritis (RA), time matters.

First, it’s important to start treatment as soon as you can to lower your risk of joint damage and deformity. Second, you need to give your biologic enough time to work. You may not see results right away. But that doesn’t mean it’s not working.

Why Biologics Need Time

Biologics, which are a type of disease-modifying antirheumatic drug (DMARD), interfere with the underlying disease process of RA. They target different parts of your immune system to stop the series of events that lead to inflammation and joint destruction.

In time, you may have less inflammation, swelling, stiffness, and joint pain. But the process takes weeks or months to take effect.

“Biologics aren’t painkillers. They don’t make you feel better overnight,” says Stuart Kaplan, MD, chief of rheumatology at Mount Sinai South Nassau hospital in Oceanside, NY. “It generally takes at least a few weeks to start feeling better and may take a few months to experience the full effect.”

How Long It May Take

Relief happens gradually. You may notice a small improvement after your first or second dose of a biologic. Over time, you could get more relief.

It typically takes 3-4 months to see a big improvement. But it can take longer, Kaplan says, even 6 months or more.

How quickly you see an improvement may depend on how often you take your biologic. If you get an injection once a week, you might start to feel better within a few weeks. If you take it less often, it could take longer.

You May Need a Different Biologic

If your symptoms don’t improve within 3-4 months, your doctor may recommend trying a new biologic.

“Not every medication works for every patient,” Kaplan says. “Fortunately, there are over a dozen different biologics on the market today.” In the last 20 years or so, many new biologics have become available.

Different types of biologics target different parts of the inflammatory process. For example, tumor necrosis factor (TNF) inhibitors, like adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab, target one type of molecule that's involved in inflammation. Other kinds of biologics, like sarilumab and tocilizumab, target others.

If one type of biologic doesn’t work for you, another might. You might need to try two or three drugs to find the right match.

Even after you find one that works, it will sometimes stop working. “Often a drug will work for a while, months or years, then symptoms break through and they need to switch to a new one,” Kaplan says.

“The important thing is to follow up regularly with your rheumatologist and keep trying different options until you’ve reached your goal,” he says.

What You Can Expect

Even when you find a biologic that works, your symptoms aren't likely to go away completely. “It’s somewhat unusual to get 100% relief,” says Kaplan.

You may have less inflammation, swelling, stiffness, and joint pain. But some pain and swelling could linger. That’s because with joint damage, what’s done is done, Kaplan says. A biologic can prevent further destruction, but it can’t fix deformed joints.

If a biologic makes you 70% better than where you started, doctors consider that a good result.

How Your Doctor Will Know Whether It’s Working

Your doctor will want to see you more often at the beginning of your treatment to see how you’re doing on your biologic, whether it’s working, and if you have side effects.

To see how it’s working, your doctor will probably give you a physical exam and ask you about symptoms like pain, swelling, and red, hot joints. They may do blood tests to look for markers of inflammation. They might also do X-rays or MRIs to see how RA is affecting your bones or joints.

Your doctor will also look for side effects and complications from your medication. Biologics are immunosuppressants, which means they weaken your body’s ability to fight germs. That makes you more likely to get infections.

At first, your doctor will probably see you every month or two to make sure you’re tolerating your new biologic. Later, you may go 3-4 months between appointments.

What to Look for at Home

If your skin is swollen, red, or hot at the site of the injection, you may be having a reaction to the biologic.

“In most cases it’s relatively minor and can be treated with ice packs,” Kaplan says. You can also try corticosteroid skin creams, antihistamine pills, or acetaminophen to make you more comfortable.

If redness, swelling, itching, or pain gets worse or lasts longer than 5 days, tell your doctor.

What to Do if You Don’t Feel Better

Talk to your doctor if you don’t feel better after a few months after starting a biologic drug. But keep in mind that the process of finding the right one takes time.

“If you don’t see results right away, don’t give up,” Kaplan says. “New drugs are coming out every day and there are even more in the pipeline.”

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SOURCES:

Stuart Kaplan, MD, chief of rheumatology, Mount Sinai South Nassau.

Arthritis Foundation: “Biologics.”

UptoDate: “Patient education: Disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (Beyond the Basics).”