“Biologics have changed the lifestyles of people with RA,” says Stuart D. Kaplan, MD,chief of rheumatology at South Nassau Communities Hospital in Oceanside, New York. Drugs that are classified as biologics have helped many people with RA reduce their pain and disease activity, according to Dr. Kaplan. Some have even helped make remission more possible, he adds, although he cautions that there’s still no cure for RA. Though biologics may have some impressive benefits, you’ll have to do some prep work before you start them — and remain vigilant while you use them. Here’s why — and how to get better prepared for treatment with biologics.

Tips for RA Treatment With Biologics

  1. Hold off on starting biologics if you’re sick. Biologic therapy impairs your immune system and increases your risk for infection. So, if you’re sick, even with just a bad cold, let your doctor know. He or she will likely delay starting biologics until you feel better, Kaplan says. If you are on biologics and you think you may have a bacterial infection, see your doctor. You’ll want to get it treated quickly so it doesn’t get worse.
  2. Get screened regularly for tuberculosis and hepatitis B while on biologics. Biologic therapy can reactivate the tuberculosis (TB) virus. Before starting biologic treatment, your doctor will screen you for TB. He or she may also screen for hepatitis B, which is another infection that biologic therapy could reactivate, says Orrin M. Troum, MD, a rheumatologist with Providence Saint John’s Health Center in Santa Monica, California.
  3. Get any necessary vaccines done before you start treatment. People on biologics can’t have vaccines with live viruses as they can pose a serious threat to your health, Kaplan cautions. This can include vaccines for varicella, MMR (measles, mumps, and rubella), and pneumonia. Dr. Troum advises patients to get up-to-date with vaccines before they start biologic therapy. Once you begin biologics, ask your doctor before you get any other routine vaccines.
  4. Get prepared for your infusion or injection. Some types of biologics are given by an intravenous infusion, while others are administered by injection. If you’re going to get an infusion, drink plenty of water in advance, Kaplan recommends. Your doctor may also prescribe a type of medicine called an antihistamine, along with a pain reliever like acetaminophen, before your infusion, Troum adds. If you’ll be getting an injection, make sure the target area of skin is intact and clean. A common side effect of biologic drugs is irritation and redness at the injection site.
  5. Don’t expect to feel better overnight. It will take some time to notice a difference in how you feel. “You’ll usually feel better, but not immediately,” Kaplan says. Give your body six to eight weeks to feel the full effects of biologics.
  6. Ask your doctor if you’ll need to change any of the medications that you take. Rheumatologists often want patients to continue their other RA treatments. But if you start to respond positively to your biologic treatment, your rheumatologist will have you cut back on those other meds, Kaplan says. You usually can continue other non-RA medications you take.
  7. Be aware of a possible increased risk for certain types of cancer. Some early research has linked biologic use to an increased risk for lymphoma and skin cancer, but questions remain, Troum says. The risk for cancer shouldn’t stop you from using biologics, at least initially, but you and your doctor should monitor your overall health while on treatment. For example, as a precaution, rheumatologists usually recommend that patients on biologics see a dermatologist at least once a year, Troum says.