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Biologics

Biologic drugs for the treatment of rheumatoid arthritis (RA) are made from proteins. They work by blocking the activity of a key chemical or cell or protein involved in inflammation that gives rise to joint swelling and other symptoms. They are powerful and specific therapies that target very particular parts of the immune system. 

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Rheumatoid arthritis (RA) is usually treated with one or more of the many disease modifying anti-rheumatic drugs (DMARDs) that are available. In various ways, these drugs calm down the activity of the immune system so that it stops attacking and damaging the joints.  

Conventional DMARDs for RA (such as methotrexate and sulfasalazine) and drugs such as steroids are effective, but they tend to suppress many aspects of the body’s immune response at once. As we have learnt more about the abnormal immune response that happens in RA, it has become possible to develop treatments that target very specific aspects of it: these are biologic therapies.  

The NICE RA Guideline states that to be eligible for biologic drugs, patients with RA should have high levels of persistent disease activity. This is measured by a scale known as the Disease Activity Score in 28 joints (DAS 28 for short), which must be 5.1 or higher if you are to be eligible for biologic therapy. (See page 13 for more about DAS28.) You must also have failed on two disease modifying anti-rheumatic drugs (DMARDs), one of which must be methotrexate taken for at least six months unless it is contraindicated for some reason.  

Biologic drugs for the treatment of rheumatoid arthritis (RA) are made from proteins. They work by blocking the activity of a key chemical or cell or protein involved in inflammation that gives rise to joint swelling and other symptoms. They are powerful and specific therapies that target very particular parts of the immune system.  

In the 1980s, it was discovered that the actively inflamed joints of people with rheumatoid arthritis contain many different chemicals that cause inflammation or contribute to it, produced by cells in the joint. Among these chemicals, proteins called cytokines were discovered, whose job is to send chemical messages from one cell to another. There are many different cytokines: some switch off inflammation while others are particularly potent at causing it.  

Biologic drugs are given by subcutaneous injection or some as an infusion into a vein. They cannot be taken by mouth.  

Medicines in rheumatoid arthritis

We believe it is essential that people living with RA understand why certain medicines are used, when they are used and how they work to manage the condition.

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