Timing is crucial when starting a biological medication for rheumatoid arthritis (RA).
Firstly, it’s important to start treatment as soon as possible to reduce the risk of joint damage and deformities. Secondly, you must give your biologic enough time to work. You may not see immediate results, but that doesn’t mean it’s not effective.
Biologics, a type of disease-modifying antirheumatic drug (DMARD), intervene in the underlying disease process of RA. They target different parts of your immune system to stop the cascade of events leading to inflammation and joint destruction.
Over time, you may experience less inflammation, swelling, stiffness, and joint pain. However, it takes weeks or months for the process to take effect.
„Biologics are not painkillers. They don’t make you feel better overnight,“ says Dr. Stuart Kaplan, Chief of Rheumatology at Mount Sinai South Nassau Hospital in Oceanside, NY. „Generally, it takes at least a few weeks to see improvement, and it may take several months to experience the full effect.“
Relief is gradual. After the first or second dose of a biologic, you may notice a slight improvement. Over time, you may experience more relief.
Typically, it takes 3-4 months to see a significant improvement. But it could take longer, even six months or more, according to Kaplan.
How quickly you notice improvement may depend on how often you take your biologic. If you receive an injection once a week, you may feel better within a few weeks. If you take it less frequently, it may take longer.
If one type of biologic is not effective for you, another might be. You may need to try two or three medications to find the right one.
Even if you find one that works, it may stop working over time. „Often a medication works for a while, months or years, then symptoms break through, requiring a switch to a new one,“ says Kaplan.
Even if you find an effective biologic, your symptoms are unlikely to completely disappear. „Achieving 100% relief is somewhat rare,“ says Kaplan.
You may experience less inflammation, swelling, stiffness, and joint pain. However, some pain and swelling may persist. This is because once joint damage is done, a biologic can prevent further destruction but not repair deformed joints.
If you improve by 70% compared to the beginning, doctors consider it a good outcome.
Your doctor will want to see you more frequently at the start of your treatment to assess how you’re responding to your biologic, if it’s working, and if you have any side effects.
To evaluate its effectiveness, your doctor will likely conduct physical examinations, inquire about symptoms like pain, swelling, and red, hot joints, and perform blood tests to look for inflammation markers. They may also do X-rays or MRIs to assess how RA is impacting your bones or joints.
Your doctor will also monitor for side effects and complications from your medications. Biologics are immunosuppressants, weakening your body’s ability to fight off germs, which can increase the risk of infections.
Initially, your doctor will likely see you every one to two months to ensure you’re tolerating your new biologic. Later on, visits may be spaced out to 3-4 months.
If your skin is swollen, red, or hot at the injection site, you may be reacting to the biologic.
„In most cases, it’s relatively minor and can be treated with ice packs,“ says Kaplan. You can also try corticosteroid creams, antihistamine pills, or paracetamol to alleviate discomfort.
If redness, swelling, itching, or pain worsens or lasts longer than 5 days, notify your doctor.
If you don’t feel better a few months after starting a biological medication, talk to your doctor. Understand that finding the right treatment takes time.
„If you don’t see immediate results, don’t give up,“ says Kaplan. „New medications are coming to market daily, with more in the pipeline.“