In order to slow the progression of rheumatoid arthritis, a class of medications called disease-modifying antirheumatic drugs (DMARDs) have been the mainstays of RA treatment for decades.
The development of biologics has been a great advance in the treatment of immune conditions like rheumatoid arthritis. See Biologics for RA and Other Autoimmune Conditions
Photo: National Institute of Arthritis and Musculoskeletal and Skin Diseases
With the introduction of biologics in the past decade or two, the effort to slow—or even stop—the progression of RA has taken great strides. By using biologics, often in combination of DMARDs, doctors have been able to find effective ways to interrupt the immune system dysfunctions that RA causes.
Biologics are effective but complicated to create
Biologics are technically a type of DMARDs. But they’re special in that they’re derived from living proteins. They can’t be chemically synthesized the way other medications can; rather, they need to be grown in large quantities of modified cells. These are some of the factors that contribute to the enormous complexity and expense associated with biologics.
Because of how biologics are different from other medications, they offer some treatment challenges:
- They can increase risk for infection.
- They can cause serious side effects that can worsen over time.
- They are expensive and high maintenance, as they need to be administered by injection or infusion in a doctor’s office.
New options offer convenience and fewer side effects
The newest class of DMARDs, known as Janus kinase (JAK) inhibitors, offer an advantage over biologics in that they can be taken orally. However, they have some of the same drawbacks as biologics: they also can cause troubling side effects and raise risk for infection.
There’s been some research that demonstrates it may be possible to reap the benefits of biologics while avoiding some of their pitfalls by using them aggressively, then tapering them once good results have been achieved. Tapering (but not discontinuing) medications is now part of the clinical treatment guidelines for RA.1
Rheumatoid arthritis can still be a struggle to manage as patients and doctors work together to find drug combinations that effectively treat RA symptoms while minimizing side effects and risks.
But the prospects for today’s RA patients are better than ever and continuing to improve.
- Jasvinder A. Singh et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care & Research. DOI 10.1002/acr.22783 http://www.rheumatology.org/Portals/0/Files/ACR%202015%20RA%20Guideline.pdf