What to Expect When Switching to Biologics for RA

Biologic drugs are one type of medication that your doctor might prescribe to treat rheumatoid arthritis (RA). They may help relieve your symptoms and reduce your risk of joint damage. But biologics can also potentially cause adverse side effects.

Learn what to expect when you take a biologic drug.

How will the drug be administered?

Several different types of biologic drugs are available to treat RA. Some are administered in pill form, while many others are given intravenously.

In some cases, you might need to visit your doctor’s office, clinic, or hospital to receive intravenous infusions. These infusions can take several hours to complete. During this process, a healthcare professional will monitor you for signs of adverse reactions. Sometimes your doctor might encourage you to take an antihistamine or other medication beforehand to reduce your risk of reaction.

In other cases, your doctor might prescribe a biologic drug that you can self- inject. Several types of biologic drugs are available in easy-to-use auto- injectors. If your insurance plan doesn’t cover auto-injectors, your doctor might provide prefilled syringes. Alternatively, you might receive unfilled syringes and vials of medication. Ask your doctor for tips on how to use these devices to inject your medication.

Your doctor can also provide more information about your recommended dosage schedule.

How long do the effects take to kick in?

If your prescribed biologic drug works as intended, it should help:

  • reduce inflammation
  • limit symptoms such as joint pain
  • stop your condition from getting worse

Depending on the specific type of biologic drug that you’re prescribed, it might take multiple doses before you notice improvements in your symptoms. In some cases, it might take several months of treatment before you experience the maximum effects. Ask your doctor how long it typically takes for your prescribed drug to provide relief.

If you don’t experience improvement in your symptoms, let your doctor know. Different types of biologic drugs target different parts of your immune system. Unfortunately, there’s no way to know ahead of time if a specific biologic drug will work for you. If one drug doesn’t work, your doctor might prescribe another.

What are the potential adverse side effects?

Biologic drugs for RA suppress your immune system. This increases your chances of infections. Depending on the specific type that you take, the prescribed biologic drug may also:

  • raise your odds of developing certain diseases, such as certain types of cancer
  • interact with other drugs, supplements, or herbal products
  • trigger an injection-site or infusion-related reaction
  • exacerbate symptoms of chronic pulmonary obstructive disease (COPD)
  • boost your cholesterol, triglyceride, or liver enzyme levels
  • cause false results in blood glucose readings
  • cause other adverse side effects

If you develop any of the following symptoms within 24 hours of taking a biologic drug, contact emergency medical services (911):

  • chest pain
  • rapid heartbeat
  • swelling of your lips, tongue, or throat
  • wheezing or difficulty breathing
  • dizziness or fainting
  • rapid or weak pulse
  • severe vomiting

If you develop any of the following symptoms after taking a biologic drug, tell your doctor right away:

  • itchiness, rash, hives, scaly patches, or sores on your skin
  • yellowing of your eyes or skin
  • easy bleeding or bruising
  • changes to your vision
  • changes to the appearance or volume of your urine
  • discomfort or pressure when you urinate
  • abdominal pain, nausea, vomiting, or diarrhea
  • numbness, tingling, or weakness in your feet or hands
  • sudden changes in your weight or appetite
  • signs of infection, such as fever, chills, muscle aches, fatigue, persistent cough, or sore throat

Mild injection-site reactions are common. For example, you might develop redness, swelling, itching, or pain around an injection site. To relieve these symptoms, it might help to use a cold compress, topical corticosteroids, oral antihistamines, or acetaminophen. If your symptoms last longer than five days, call your doctor.

Many biologic drugs aren’t recommended for people who are pregnant or nursing. If you become pregnant while taking a biologic drug, tell your doctor right away.

You should also talk to your doctor before undergoing surgery, getting vaccinations, or taking new medications, supplements, or herbal products while taking a biologic drug.

What tests will I need to undergo?

Your doctor might ask you to undergo medical tests before, during, or after treatment with a biologic drug. This can help them assess and manage your risk of adverse side effects. For example, it can help them check for signs of infection, liver damage, high cholesterol, high blood pressure, congestive heart failure, or cancer.

For example, your doctor might order one or more of the following tests:

  • skin or blood tuberculosis test
  • hepatitis B virus screening
  • liver enzyme or liver function test
  • complete blood count
  • lipid panel
  • blood glucose test
  • blood pressure test
  • heart monitoring
  • skin examination

Ask your doctor for more information about any tests that you should take before, during, or after treatment with a biologic drug.

How will the rest of my treatment plan change?

In some cases, your doctor might prescribe a biologic drug to replace another medication that you’ve been taking. In other cases, your doctor might simply add the biologic drug to your treatment plan.

Taking multiple biologic drugs at the same time can increase your risk of adverse side effects. However, your doctor might encourage you to use a biologic drug along with other non-biologic treatments. For example, your doctor might recommended one or more of the following:

  • non-biologic disease modifying antirheumatic drugs (DMARDs), such as methotrexate
  • nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • corticosteroids, such as prednisone
  • occupational or physical therapy
  • use of assistive devices or braces
  • massage or other complementary therapies
  • changes to your exercise routine, diet, sleep patterns, or stress management habits
  • strategies to reduce your risk of contracting infections

Ask your doctor if there are any medications, supplements, herbal products, or vaccinations that you should avoid while taking your prescribed biologic drug.

The takeaway

Taking the right biologic drug can help reduce symptoms of RA and protect your joints from damage. But it’s important to take steps to prevent, recognize, and respond to potential adverse side effects. Ask your doctor for more information about your prescribed drug, including how it’s administered, when you can expect it kick in, and how you can limit and manage potential side effects.

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