Why Doesn't a Biologic Drug Help My RA Symptoms?

Medically Reviewed by David Zelman, MD on August 11, 2021

There are a lot of reasons your biologic drug for rheumatoid arthritis (RA) might not work the way you hoped it would. Sometimes, it's just not right for you and you need to move on to another treatment. Other times though, you can make some changes to help it work better for you.

Your doctor can help you figure out what's going on. Tell them about how you've been feeling since you started a biologic. They'll let you know if some of these common things are the reason your medicine isn't helping you get better:

You don't have the right biologic.

Biologics curb your immune system -- your body's defense against germs. Each drug targets a different, small piece of the system. That's partly what makes them so good, but it also means they're not a one-size-fits-all treatment.

It could be that your biologic just doesn't target what you need it to. A biologic that works great for one of your friends may not do anything for you.  

And there's no telling ahead of time which biologic is right for you. With your doctor's help, you'll need to do a bit of trial and error to see which drug is best.  

You need more treatment along with your biologic.

RA is complex, and there could be many different causes for your symptoms. Your biologic may help with one, but not others. That's why it's usually just one of the tools you'll need for the best results.

Your body is fighting it.

A biologic can work great for years but then, at some point, have no effect at all. When that happens, it sometimes means your body has started to reject the drug.

You're just going through a normal "up and down" period.

About 1 in 3 people with RA, no matter how they treat it, go through times with more severe symptoms and times with none.

Your doctor can help you figure out what's going on. Together, you can look at your history to see if it's more likely the biologic or part of your regular ups and downs.

You need a bigger dose or to take it more often.

If your doctor gives you your biologic through an IV, sometimes it helps to increase the dose. This isn't an option for a biologic you give to yourself at home. Instead, your doctor might suggest you take the biologic more often.

You need to give it more time.

Biologics can take up to 6 months before you see the full results. If you find that some symptoms improve in the first few months, it may help to give it more time to see how it goes.

Your biologic is helping, but not as much as you'd like.

You'd think it'd be clear-cut to know if a biologic works or not, but everyone with RA has their own experience.

Some people expect remission -- when symptoms go away -- while others hope for less intense symptoms or fewer flares. You can talk to your doctor about your goals for the biologic and if it's meeting your needs or not.

You might not be taking or storing it quite right.

If you give your biologic to yourself at home, make sure to closely follow all directions. It's important to:

Make sure all the medicine goes in. This isn't a common problem, but it's one to keep an eye on.

Stay on schedule. You usually take biologics once every 2 or 4 weeks. It's important to stay on track, but if you're a day or two late, you'll be OK. If you go longer than that, it might cause issues.

Store it at the right temperature. Don't let your biologic get too warm or too cold. Since you need to keep it in the fridge, too cold is the more common problem.

You have other health problems with similar symptoms.

In some cases, your biologic is working, but other conditions you have make it seem that it's not. This can happen if you have fibromyalgia, osteoarthritis, and other issues that cause pain, swelling, stiffness, and tiredness.

Since your biologic won't help these other conditions, they'll still cause symptoms, meaning that RA might not be the issue.

You've been smoking.

Some biologics may not work as well if you smoke. If you smoked in the past, that won't matter. But if you're doing it now, that could be a problem. Talk to your doctor to get ideas on the best way to break the tobacco habit.

You're overweight.

Doctors are still working out why, but biologics don't seem to work as well when you're overweight. They've also found that if you drop pounds, your meds will become more effective.

WebMD Medical Reference



Laura Cappelli, MD assistant professor of medicine, division of rheumatology, Johns Hopkins University School of Medicine.

Donald Miller, PharmD, professor, pharmacy practice, School of Pharmacy, College of Health Professions, North Dakota State University.

Arthritis Foundation: "Biologics Overview," "Why Your RA Went into Remission, But Relapsed," "RA with a Side of Fibromyalgia," "How Fat Affects Rheumatoid Arthritis."

National Rheumatoid Arthritis Society: "Getting Established on DMARD Therapy."

PubMed: "Patients with early rheumatoid arthritis who smoke are less likely to respond to treatment with methotrexate and tumor necrosis factor inhibitors: observations from the Epidemiological Investigation of Rheumatoid Arthritis and the Swedish Rheumatology Register cohorts."

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