Biologic Treatments for Inflammatory Arthritis

A biological medicine, or biologic, is a type of treatment for some long-term medical conditions like axial spondyloarthritis, ankylosing spondylitis, psoriatic arthritis and rheumatoid arthritis.

Unlike traditional medications like ibuprofen or paracetamol, biologic medicines are made from living organisms. The material they are made from can come from many sources, including humans, animals and microorganisms such as bacteria or yeast.

Most biologics are designed to block specific parts of the immune system and can be thought of as ‘targeted therapies’. Because these therapies are proteins, they do not work as tablets and have to be given as a drip or injection.

Biological therapies are only given to people who have already tried other treatments appropriate to their condition and not responded well to them. Biological therapies are often given alongside other medications such as methotrexate.

The main aim of biologic treatments is to improve quality of life. Biologic medicines can help to reduce excess inflammation, pain and stiffness. Hopefully, this will mean you can get moving quicker in the morning, find it easier to carry out your daily activities, be able to exercise more and sleep better.

Biologic medicines can't reverse any damage that has already occurred to your joints, but research has shown that many people with long-term conditions can still have significant improvements in their symptoms.

For most people, any side effects they have can be treated by their doctor, so they do not need to stop taking their biologic medicine. Occasionally some people have to stop their biologic medication due to side effects. Your rheumatologist or GP will be able to explain these possible side effects.

People who don’t see an improvement in symptoms (it may take 3–6 months to be certain), or who get serious side effects, will usually be recommended to stop their biologic medication. If it’s safe and suitable to do so, your rheumatologist may suggest trying a different biologic medicine. Not every biologic medicine works in the same way. So, if one doesn’t work, another one might.

There are four types of biologic therapy which have been approved for use within Canada to treat the different forms of inflammatory arthritis. They all work by reducing the excess inflammation present in body.

1. Tumor necrosis factor alpha inhibitors (Anti-TNF)
2. Interleukin inhibitors (Anti-IL)
3. B-cell therapy
4. T-cell therapy

Anti-TNF treatment

Anti-TNF treatments disrupt the action of a protein called tumour necrosis factor (TNF) which is over-active in people with inflammatory arthritis.

Too much TNF causes inflammation and damage to bones, cartilage and tissue. Anti-TNF treatments block how TNF works and can reduce the amount of excess inflammation present in your body and joints.

Anti-IL treatment

People with inflammatory arthritis have very high levels of proteins called interleukins in their body. Interleukins play a very important role in causing the excess inflammation associated with inflammatory arthritis. Anti-IL treatments work by neutralising the activity of certain interleukins and can reduce the amount of excess inflammation present in your body and joints.

B-cell therapy

The immune system normally works to protect the body from infections by causing inflammation. Inflammatory arthritis causes a group of cells in the body’s immune system, called B-cells, to attack the body’s own tissues by mistake. B-cell therapy works by lowering the activity of B-cells, to reduce inflammation, pain and swelling.

T-cell therapy

T-cells are a group of cells in the body’s immune system that attack the body’s own tissues causing swelling and joint damage in people who have rheumatoid arthritis. T-cell therapy works by stopping T-cell from communicating with one another and this helps to reduce inflammation.