Before biologics came into existence, people with rheumatoid arthritis (RA) often faced severe joint deformity. While joint destruction and joint deformities still occur in people with RA, often times the early introduction of a biologic drug can slow the progression of the joint damage, sometimes halting it altogether.

The advancements in RA treatment have been profound in recent decades. But while biologics have improved the quality of life for many people with RA, these medications aren’t without their risks.

The lowdown on biologics

Biologic drugs revolutionized the treatment of RA by targeting specific cells in the immune system that play a role in the manifestation and disease process. With these more precise disease management efforts, patients on biologics have often seen a decrease in bone involvement and less destruction of the synovial tissue and cartilage of the joints.

Biologic drugs essentially mimic antibodies produced by the human body. This is unlike many medications that are made with chemicals. The substances in biologic drugs block out certain components of the immune system that cause inflammation. This is different from many of the older anti-inflammatory drugs used to treat RA. But while biologics may be more effective than older drugs, this doesn’t mean they’re always safer.

Biologics may help improve disease flare-ups and joint deformities, but they don’t help with everything. People on biologics often still live with other symptoms associated with RA, such as fatigue. The goal of biologic treatments is to prevent joint deformity, but it’s not guaranteed.

What are the benefits of biologic drugs?

While some rheumatologists disagree on how early to introduce biologics, most agree that there are many benefits to using biologic drugs to manage RA.

The first biologic agents approved for the treatment of RA were TNF-inhibitors, which stands for anti-tumor necrosis factor-inhibitors. These agents include etanercept (Enbrel) and infliximab (Remicade). Researchers have proven the efficacy of these biologic drugs in the short-term. However, a large percentage of patients develop an acquired drug resistance.

One concluded that the use of DMARD and biologic DMARD therapy can help improve function and decrease further joint destruction. However, the same study warned that the use of biologics comes with side effects and long-term risks.

Many doctors agree that most joint damage in people with RA occurs early in the disease process, often within the first 2-3 years. This is why more rheumatologists are now of the mindset to get patients on biologic drugs early. Treatment can help prevent or delay some joint damage from occurring. Joint damage is caused by the inflammatory process, so that’s the component of RA that needs to be better-controlled from the outset. There’s no evidence that NSAIDs — the former standard “first line of defense” in managing RA — effectively controls the type of inflammation stemming from RA.


What are the risks of biologic drugs?

People with RA should weigh the benefits and risks of drugs like biologics and biosimilars, which are a less costly imitation of biologics. Many biologic drugs come with an increased risk of serious side effects, such as: 

  • increased chance of infection
  • cardiovascular or circulatory problems
  • headaches
  • nausea
  • increased risk of certain cancers with long-term use

The evidence of benefits, though, may be enough to persuade healthcare providers to recommend biologic drugs as an early option for the treatment of moderate-to-severe RA.

What are my options?

There are many types of biologic drugs on the market to treat many conditions, including RA. Biologics commonly used to treat RA include:

  • tocilizumab (Actemra)
  • certolizumab (Cimzia)
  • etanercept (Enbrel)
  • adalimumab (Humira)
  • anakinra (Kineret)
  • abatacept (Orencia)
  • infliximab (Remicade)
  • rituximab (Rituxan)
  • golimumab (Simponi)
  • tofacitinib (Xeljanz)

Now, biosimilars are also being introduced. These less costly imitations of biologics include Zarxio and Inflectra.

If you’re considering biologics as a treatment for RA, speak with your doctor and learn more about each drug, how it works, and its potential side effects. While these drugs do have some risks, they can help you stay mobile and reduce pain and joint damage.