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Biological treatments for rheumatoid arthritis

Biological treatments, sometimes called biologics, are a newer form of treatment for rheumatoid arthritis.

Biological treatments include TNF-alpha inhibitors, such as etanercept, infliximab, adalimumab, certolizumab, rituximab and tocilizumab.

How do biological treatments help rheumatoid arthritis?

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

Biological treatments 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 system.

What are the side effects of biological treatments?

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

Biological treatment may also cause some chronic diseases that are dormant (such as tuberculosis) to flare up, 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 biological treatment.

Since biological treatment is still in the early stages of use, some of the long-term effects of these medications simply aren't known. Your doctor will want to monitor your health regularly while you are taking them. However, the evidence so far is that they work well, especially if DMARDs are ineffective or contra-indicated - a factor that makes taking the drug too risky.

One disadvantage of current biological treatments 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 foetus, these studies cannot always predict the effects in humans. Pregnant women should not be given these drugs.

Biological treatments are commonly discontinued before surgery, until wounds have healed and the risk of infection has passed.

As a general rule, different biological treatments should not be taken at the same time.

Researchers say that future biological treatments, still in the early stages of development, may be less expensive and that 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 details of some of the available biological treatments:


Entanercept reduces joint inflammation and damage from rheumatoid arthritis by blocking a chemical activator of inflammation called tumour necrosis factor (TNF).

It is given by injection under the skin once or twice a week. Patients can learn to manage their own injections, or a family member or carer who has been taught how to do it can administer it. Kits that make preparing the drug and injecting it easier are available from the manufacturer. Moreover, pre-loaded syringes are available as self-injectable “click-pens”.

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