Biologics act on the immune system. The cells of the immune system communicate using chemicals called cytokines. Experts believe that the reason the immune system attacks the joints in people with RA is that they have too much of certain cytokines, including tumour necrosis factor alpha (TNF-1) and interleukin (IL), and that these cytokines could be sending messages to attack the joints. Some biologics target these cytokines and block their effects.



Other biologics work by blocking certain white blood cells (also part of the immune system) from becoming activated and attacking the joints. The actions of biologics on the immune system help to prevent the inflammation of RA, which therefore helps relieve the symptoms and prevent the joint damage of RA. Some biologics can also improve physical function.

Biologics are used for moderate-to-severe RA. Some biologics may be used alone or in combination with other RA treatments.

Infliximab (Remicade) used in combination with methotrexate, etanercept (Enbrel) used alone or with methotrexate, and adalimumab (Humira) used alone or with methotrexate or with other DMARDs (disease modifying anti-rheumatic drugs) can relieve RA symptoms, slow down and prevent further joint damage, and improve physical function. Anakinra (Kineret) used alone or in combination with DMARDs can relieve symptoms and slow down joint damage.

Abatacept (Orencia) used alone or in combination with DMARDs can relieve RA symptoms, slow down and prevent further joint damage, and improve physical function in people who have not gotten results from one or more DMARDs or TNF-blocking therapies (such as infliximab, etanercept, or adalimumab). Rituximab (Rituxan), used in combination with methotrexate, can relieve symptoms of moderate-to-severe RA in people who have not gotten results from or could not tolerate one or more TNF-blocking therapies.

Early and aggressive treatment is recommended for people with RA to achieve disease control, prevent joint damage, alleviate pain, and maintain or delay joint function. Biologics may start to work within days to weeks, and full effects are seen in 3 to 4 months.

Infliximab (Remicade) works by blocking tumour necrosis factor alpha (TNF), an immune system chemical that sends signals leading to joint swelling and damage. Infliximab can be given as few as 6 times a year as a 1- to 2-hour intravenous infusion (where the medication is given into a vein under supervision of a trained health care professional). The infusion may be given in either a hospital or a private clinic setting, commonly referred to as an "infusion clinic."

Etanercept (Enbrel) works by blocking TNF-1. It is usually self-injected under the skin once or twice a week (from 52 to 104 injections per year).

Anakinra (Kineret) works by blocking interleukin-1 (IL-1), an immune system chemical that sends signals leading to joint swelling and damage. It is usually self-injected under the skin once daily.

Adalimumab (Humira) works by blocking TNF-1. Adalimumab is usually self-injected under the skin once every other week (about 26 injections per year).

Abatacept (Orencia) works by blocking T cells (a type of white blood cell) from becoming activated and attacking the joints. It is given as a 30-minute intravenous infusion (where the medication is given into a vein under supervision of a trained health care professional) in a hospital or private clinic setting, commonly referred to as an "infusion clinic." It is usually given every 4 weeks.

Rituximab (Rituxan) helps treat rheumatoid arthritis, when one or more TNF-blocking therapies have failed or could not be tolerated, by reducing the number of B cells in the body, which are involved in inflammation. Rituximab is given as an intravenous infusion (where the medication is given into a vein under supervision of a trained health care professional) in a hospital or private clinic setting, commonly referred to as an "infusion clinic." Each course of treatment involves 2 separate infusions given at least 2 weeks apart.

Your rheumatologist may recommend regular checkups and blood tests while you are taking biologics. The side effects of biologics depend on the medication used, and may include nausea; abdominal pain; headaches; or redness, itching, pain, or swelling at the injection area (more common with medications given as a subcutaneous injection).

If you are on a biologic at any time, contact your rheumatologist as soon as possible if you have an infection (fever or chills) or if you have symptoms of liver problems (such as yellow eyes or skin, abdominal pain, pale stools, or dark urine) or bleeding.

Some medications developed for rheumatoid arthritis involve administration of the medication by an intravenous (IV) infusion. Infusion clinics are staffed with trained infusion nurses and doctors who provide support and supervision while you receive your medication.

Throughout the infusion, a nurse will check on you at regular intervals. These clinics are designed to provide a comfortable environment for the patients. Some people receiving their medication choose to pass the time by reading a book, watching television, or discussing with other patients who have the same condition.

Corticosteroids work by decreasing the activity of the immune system. This helps relieve the pain and inflammation caused by RA. Corticosteroids are used when quick relief is needed, such as during RA flare-ups.

Corticosteroids may be taken as pills, injected into a joint by your doctor, or injected into a vein (in a hospital).

Long-term use of corticosteroids can lead to osteoporosis (thin bones), cataracts, weight gain, thin fragile skin, stomach or intestine ulcers, slow wound healing, increased blood pressure, diabetes, and fluid retention. For this reason, corticosteroids are usually limited to short-term use.