Biologics are the latest type of prescription medication for rheumatoid arthritis (RA). They work by affecting the actions of certain chemicals in the body that are involved in inflammation. They are a newer type of disease-modifying anti-rheumatic drug (DMARD), which means they can help slow the progression of RA, reduce joint damage, and keep inflammation under control.

“There’s some debate about them, but in general, biologics work pretty well,” says Robert Shmerling, MD, clinical chief of rheumatology at Beth Israel Deaconess Hospital in Boston. “When compared one-on-one with traditional medications, the response and improvement rates in RA generally have been higher with biologics.”

The debate, Dr. Shmerling says, happens when doctors compare the effectiveness of combinations of traditional RA medications with the effectiveness of a single biologic medication. Many doctors find that many people with RA respond well to a traditional DMARDs and don’t feel the need to prescribe a biologic because they’re generally more expensive and must be injected at home or infused at a medical facility.

In practical terms, this means that the prime candidate for biologic therapy is typically a person with RA who hasn’t found success using traditional, less expensive medications, Shmerling says.

Biologics for Rheumatoid Arthritis Treatment

The first biologic medication for RA was introduced in 1998. Since then, many other biologics have become available. They all treat RA by reducing inflammation, but accomplish it in different ways. Here's how each biologic treatment type works:

  • TNF inhibitors. These biologics work by blocking tumor necrosis factor-alpha (TNF-α), a protein that can cause inflammation. There are a handful of different TNF inhibitors available today, and each one blocks TNF in a different way, but the action is similar, Shmerling says.
  • IL-1 blockers. The action of this type of biologic is similar to that of TNF inhibitors. However, it works by blocking interleukin-1 (IL-1), a protein that’s seen in excess in people with RA.
  • IL-6 blockers. This medication specifically targets interleukin-6 (IL-6), another protein that can prompt inflammation.
  • T-cell co-stimulation blockers. Instead of blocking specific proteins, these medications affect T-cells, which are white blood cells that can kill other cells in the body and cause inflammation. “These drugs don’t allow the T-cells to become as active as they would normally be,” Shmerling says. “Basically, there are two different receptors that need to be blocked, and that’s what this type of medication does.”
  • Anti-CD-20 antibodies. These medications halt the activation of B-cells, which helps to calm down the immune system and reduce inflammation. This medication has been used for many years for the treatment of lymphoma, a cancer of the lymphatic system, and was approved a few years ago for people with RA.

Biologics for Rheumatoid Arthritis: Side Effects and Safe Use

The most common side effect of biologics is skin irritation at the site of the injection. People taking biologic drugs also have a higher risk of developing tuberculosis (TB), fungal infections, and other types of infections. In addition, biologics have been associated with an increased risk of cancer, including lymphoma.

Before starting a biologic treatment, some people need to get vaccinated to prevent certain types of infection, like the flu. People taking biologics are generally advised to avoid vaccinations that contain live viruses, like the nasal flu vaccine, and family members should avoid these as well. You may want to ask your doctor about getting a shingles vaccine before you start a biologic, as well. A TB screening may also be necessary before beginning biologic therapy.

As with any medication regimen, be sure to talk to your doctor if you have questions about your RA treatment plan.