Signs That Your Biologic for RA Isn't Working

Medically Reviewed by David Zelman, MD on August 12, 2019

It sounds like a simple question: Is my biologic drug working or not? Like a lot of things with rheumatoid arthritis (RA) though, there's not always an easy answer.

Part of what makes it hard is that for 1 in 3 people, the first biologic you try may not work. And when it does, it can take months before it really kicks in and you see what it can do.

Plus, the idea of what it means to work or not work isn't black and white. For some people, it means their symptoms stop. For others, it means they get fewer flares or their symptoms aren't as strong.

That's why it helps to know some signs that you can keep an eye out for. They may not tell you for sure that you need a new treatment, but if you notice them, it's a good time to talk to your doctor.

Your symptoms don't improve, or they get worse.

It can take up to 6 months before you see the full effects of a biologic, but you usually notice some changes before that. If it's been 3 months and your pain, swelling, and stiffness haven't budged -- or things have gotten worse -- it might be time to move on to new medicine.

Keep in mind that biologics often don't help as much with tiredness, so that's probably not the best way to tell if it's working.

You may also find there's a gray area where you're not sure yet how well your medicine is helping. If it's been a few months and you've had some improvement, even if it's not as much as you'd like, you may need to give it more time.  

You still have flares, or they get more intense.

Ideally, you'll have fewer flares and they won't be as strong while you take a biologic. If that's not happening, or if it did for a while and has changed, it could be time to check with your doctor to see if you need to switch meds.

This can be a tough one to figure out because other things, like stress or an injury, can trigger flares, too. And a lot of people still get flares with any treatment.

So a flare here or there could be normal. But if the trend is symptoms and flares getting worse, happening more often, or having a bigger impact on your daily life, those are pretty good signs you might need to change treatment.  

You're having a hard time with everyday activities.

Sometimes your symptoms give you clues, and sometimes it's what you're able or unable to do that really drives it home.

If you find you're still having a hard time with things like dressing, eating, or tasks at work, it could be a sign your biologic isn't helping.

You have new symptoms.

New trouble, like pain in a different joint, is definitely a red flag. You wouldn't expect that from a biologic that's getting the job done.

You feel good for a while … and then you don't.

You could go months or even years with a biologic that's working like a champ. But then you notice your old symptoms, like pain, stiffness, and swelling, start to creep in. Or, they swoop back all at once.

You might also notice that you're getting symptoms a few days before the next dose of your biologic.  

All of this could mean your body isn't responding to the biologic and it's not going to work for you anymore. If symptoms don't come back for long or they're not too strong, your medicine may still be OK. But if flares are knocking you down, it's probably time to switch.

You have an infection.

Your biologic might be great for your symptoms, but it may not work for your body in the bigger picture.

The most common problem that leads people to change biologics is an infection that's unusual or keeps coming back. Since biologics curb your immune system -- your body's defense against germs -- this is an important one to keep tabs on. Something that's usually a minor infection can turn into a big deal when you're on a biologic.

You can't shake the feeling that it's not working.

As you look for clues that your biologic isn't quite right for you, don't ignore the most basic thing: how you feel. The goal is to treat your symptoms and to help you live a full life.

So it's important to talk to your doctor if you feel like your biologic is falling short. The two of you will work as a team to figure out what's best. To do that, you need to share your experience, fears, and doubts, so your doctor has the whole picture.

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.

American College of Rheumatology: "My Anti-TNF Isn't Working: What Now?"

Johns Hopkins Medicine: "Rheumatoid Arthritis Treatment."

Arthritis Foundation: "Why Your RA Went into Remission, But Relapsed."

National Rheumatoid Arthritis Society: "Biologics: The Story So Far."

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