When rheumatoid arthritis treatment with NSAIDs and DMARDS have not been effective enough the next line of defense in the treatment of RA is the Biologic DMARDS. These medications target specific parts of the immune system. They can be very effective but they also carry an increased risk of side effects that may be severe.
RA is a disease where your bodies own defense mechanisms seem to be attacking your own cells instead of attacking foreign cells that have found their way in.
The most common Biologic DMARD acts to suppress Tumor Necrosis Factor (TNF) which is a normal part of your immune system.
Tumor Necrosis Factor
TNF is a molecule that is produced by white blood cells. It causes inflammation and normally it causes death to any foreign cells that it encounters.
When you have RA large numbers of white blood cells and large amounts of TNF accumulates within your joints.
In a rheumatic joint the TNF plays a critical role in causing joint damage.
Biologic rheumatoid arthritis treatments such as etanercept(Enbrel), infliximab(Remicade), and adalimumab(Humira) work to prevent joint damage by blocking the effects of TNF.
Rheumatoid Arthritis can cause joint damage and permanent impairment.
Image thanks to Wouterstomp via Wikimedia Commons
Risks of Infection
The most common side effect of TNF inhibitors is a risk of infection which can be mild or severe.
The same drug that blocks the effects of TNF in your joint also blocks the effect of TNF in your lungs and in other areas of your body making you more susceptible to attack by foreign invaders (infection).
Lung, Skin and Urinary Tract
Most commonly seen are pneumonia and upper respiratory infections, skin infections, and urinary tract infections, but infections in any part of your body are possible.
Currently, most doctors will stop the Biologic DMARD while you are being treated for an infection. But, this is being studied and may not be absolutely necessary in the future.
T-cell Costimulatory blockade
Another class of Biologic DMARDs is known as a T-cell Costimulatory blockade. These have their effect by interfering with the mechanism that causes T-cell lymphocytes to become active.
Exercise is important when living with RA. Pool exercises and cycling on a stationary bike are the most joint friendly exercises.
Blocking Specialized T-Cells
T-cells are specialized white blood cells that are part of your immune system and normally they just drift around without much activity.
However, when they are activated by other parts of the immune system they become very active.
Dormant then Become Active
They begin rapidly dividing into more T-cells and they begin producing many different cytokines, including Tumor Necrosis Factor, that produce inflammation.
Activated T-cells normally destroy any infected cells and any foreign cells that they come in contact with; but it a rheumatoid joint they contribute to the destruction of your body’s natural healthy joint tissue.
This group of medications blocks the activation of the T-cells by binding to receptors on the surface of the T-cell. Blocking these receptors prevents the other parts of the immune system from activating them.
Still the Risk is Infection
As with all of the Biologic DMARDs a common side effect of suppressing the immune system is increased risk of infection. Most common infections seem to affect the lungs and upper respiratory system.
These medications are not recommended for people with COPD and screening for tuberculosis is recommended before starting treatment to prevent severe adverse reactions.
Other Biologic DMARDs
Other Biologic DMARDs work in different ways to treat RA.
The one thing they all have in common is that they suppress your immune system in one way or another.
This group of rheumatoid arthritis treatments can be very effective and scientists are working to find ways to limit the risk of side effects.