It’s possible you’ve heard of people taking biologics for ankylosing spondylitis, psoriatic arthritis, or other inflammatory conditions and wondered if it’s right for you. Biologics are a type of disease-modifying antirheumatic drug (DMARD) that can treat inflammatory conditions like arthritis.
If you have ankylosing spondylitis, your back may be stiff or painful every morning. Depending on your diagnosis and situation, you may be able to take a nonsteroidal anti-inflammatory drug (NSAID). If those don’t work, you might try other medications, like ankylosing spondylitis biologics. (Remember that your treatment options may change over time based on new research and available therapies; keep in touch with your doctor to discuss your options.)
1. Biologics are targeted therapies.
Ankylosing spondylitis and psoriatic arthritis are autoimmune diseases that cause inflammation in the spine joints. Biologic medications work by targeting the part of your immune system that contributes to inflammation and preventing an overactive autoimmune response.
If your condition hasn’t responded well to treatments or hasn’t been well controlled, your doctor may prescribe cytokine inhibitors. TNF inhibitors are the most commonly prescribed biologics for spinal inflammation. Another name for this type of biologic is TNF blocker. TNF is a protein that causes inflammation in diseases such as ankylosing spondylitis. If one TNF inhibitor doesn’t work for you, your doctor may suggest trying another.
IL-17 blocker This type of drug stops inflammatory cytokines from signaling to immune cells to cause inflammation.
Both drugs are inhibitors. They’re interfering with a process that causes the inflammation you’re experiencing. That is, they stop the action that causes your stiff back and hips.
2. Biologics are injected.
Biologics are administered via infusion or subcutaneous injection, so they aren’t as simple as popping a pill.
Infusions require a hospital or clinic visit. During this time, you can listen to a podcast, read a book, check your phone for emails, or just relax. “Some patients find it relaxing,” says Dr. Alexander Geevarghese of Northwestern Medicine Central DuPage Hospital. There are also home infusion programs where a nurse comes to your house and administers the medication. If your schedule is unpredictable or you travel frequently, ask your doctor if infusions are right for you. Your doctor can help you find a schedule that works for you.
Unless a family member, roommate, or friend administers the injection, injectable biologics require more hands-on care. Otherwise, you can self-administer the medication, which must be kept chilled. One advantage of using injectables is that you can take them on vacation as long as you keep them cold.
If you’re afraid of needles, Dr. Ellen Gravallese, chief of the division of rheumatology, inflammation, and immunity at Brigham and Women’s Hospital, says you’ll get used to them. Ask your doctor if someone in the office can help you give your first shot. (Some doctors’ offices allow you to practice injections with a nurse.) 3. Biologics may cause side effects.
3. Biologics may cause side effects.
Because biologics target specific immune system components rather than the entire immune system, they may have fewer side effects than oral immunosuppressive medications. However, all medications have potential side effects, and biologics are no exception. The side effects vary by drug. When starting a new medication, don’t be afraid to ask your doctor about side effects. Your doctor may not know how a medication will affect you, but you can ask about common side effects.
Biologic reactions at the infusion or injection site are the most common. You may experience redness, pain, swelling, or itching where the needle was inserted. Dr. Maximilian F. Konig, rheumatologist and instructor in the division of rheumatology at Johns Hopkins University School of Medicine, says this reaction is usually mild and benign.
Because biologics suppress the immune system, you may be more susceptible to infections. If your doctor doesn’t bring it up, ask if there are any precautions you can take to reduce your risk of getting sick.
4. Biologics work slowly.
Symptoms can improve within weeks of starting a biologic, according to Dr. Geevarghese. However, you may need to take this medication for several months to see results.
The response time varies from person to person, says Abin Puravath, M.D., of the Johns Hopkins University School of Medicine. “Some patients see dramatic symptomatic improvement within days, while others take much longer,” Dr. Puravath saids.
Keeping track of your symptoms (including how you feel, how often you experience them, and when they occur) may help you better understand how a medication affects you.
5. It takes time to find the right biologic.
You might start to wonder if you’ll get the pain relief you want from biologics. Dr. Danve advises telling your doctor if your symptoms haven’t improved in six months. He says he assesses a biologic’s suitability after three months. The best biologic may take a few tries to find.
You and your doctor may decide to keep receiving a drug that helps you control your disease and feel better (as long as it continues working). The goal of treatment is to relieve symptoms and reduce inflammation, allowing you to do more of the things you want to do. You can take the same drug for years if you tolerate it and it works for you.
Finding a treatment plan that works for you can take time. When pain doesn’t control every aspect of your day, your life improves.