Biologics and Arthritis Pain. A new option.

Biologics

• Biologics, for those who are not familiar with the term, are newer drugs which show some very real promise in the treatment of arthritis, or Degenerative Joint Disease (DJD). Recent years have shown some wonderfully promising new treatments for those, whose bodies are not responsive to other drugs, particularly the type that modifies the disease process. One of the most important advances has been the arrival of the biologic drugs, or those which do not modify a disease process, but rather exacerbate or suppress some aspect of the disease or the immune system response to it.

• How do they affect Arthritis.

  Biologics are proteins which have been modified genetically by medical engineers to either complement or instead slow and halt the processes of the body. The drugs themselves are human in origin, being components of a human protein. Biologics target an aspect of the human immune system called cytokines, which are responsible for increasing or decreasing the inflammation that causes the arthritis, and is responsible for a great deal of the pain which is involved in that condition..

Biologics That Treat Arthritis:

• Enbrel • Humira • Kineret • Remicade • Rituxan • Orencia

• Several more are currently under study to treat more diverse types of arthritis and DJD. The action of three of the drugs is to forestall an immune system component – a cytokine known as TNF. While one will inhibit the uptake of a cytokine known as interleukin, another, Rituxan, will act on only one specific immune system cell.

• Biologics are unique in their action from other drugs because they affect only one aspect of the immune system, while other drugs will change the entire system process. The theory is that the drugs will therefore have far fewer side effects or ill effects than a medication that is broader in its affect.

What Are the Side Effects?

• Nearly any drug can cause some side effects. Many times they are positive in nature, and are found to be helpful in treating other disease processes as well. Two major side-effects are:

1. One of the side effects of biologic drugs is that because they target your immune system, it is possible that they might make the body more susceptible to other types of illness, specifically infections, but also some types of disease, particularly those biologics which suppress some actions of the immune system.

2.Biologic treatment regimens can also in some cases end a remission of another disease process, such as TB, or MS, and are not useful in treating people with those conditions, as well as some with specific types of heart disease. Physicians will test each person for tuberculosis before beginning a therapy that includes biologic drugs to be certain that they are negative before starting.

• Biologic drug treatment is still in its infancy. There have been few tests which can predict what the effects might be of a long term treatment with these drugs. As such, most physicians will want to see you more frequently to monitor how your body and immune system are responding to this type treatment.

• Further, many patients do not wish to be treated with biologic drugs because they must be used by other methods. That is to say that they are available for your use only through injection or intravenous therapy, and as such are considered an invasive procedure that many people are unwilling to endure. Intravenous therapy with biologic may take as long as two hours to complete.

• The positive aspects are that the drugs have great promise and offer a significant reduction in the pain and stiffness of arthritis.

• The conclusion of animal studies with biologic drugs predict that there will be no issues with the reproductive organs, and no lessening of fertility was noted, nor was there any problem with the gestation or delivery of the fetus, however, as with any other drug, animal testing cannot always accurately show us the effect of a given drug on humans. Those who are pregnant or would like to become pregnant are advised against using biologics unless there is no other method of control of their arthritis.

• Physicians will need to be monitoring their patients closely and the patient needs to be aware that if he or she develops any kind of fever or infection they must see their doctor immediately to prevent the process from worsening while taking biologics.

• Other conditions that should be mentioned are that two types of biologic drugs should not be given at the same time.

• The medical personnel responsible for research of these drugs predict that those which come later will be somewhat less costly and can perhaps be used orally, rather than by injection.

Drug Overview

• Enbrel aids in lowering the amount of joint inflammation. It can be used by injection only. Patients are taught to self treat themselves with a kit that is provided.

• Humira is taken only bi-monthly and may also be self injected. Patients need to monitor themselves for excessive bruising and report this to their doctor.

• Kineret lessens the inflammation by blocking certain aspects of the immune system. It is also given only by injection, but must be taken daily. It has a much lower rate of success than some of the others.

• Remicade aids in reduction of inflammation. Must be given by a physician or nurse by IV. Treatment takes about two hours per session.

• Orencia is also given by IV therapy, it can be less useful in those with COPD, or breathing problems. Those who are pregnant or nursing should consider all of the risks of this drug prior to using it.

• These drugs are very expensive, often thousands of dollars a month and are out of reach for many people.

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