Biologic Therapy in Rheumatic Diseases

A biologic drug is a drug used to treat diseases, such as rheumatic disease, in which there is a dysfunctional immune system. It modifies the biologic response in a disease state and is therefore named “biologic therapy.”

These drugs have greatly modified the way rheumatologists treat rheumatic patients, improving the patients’ prognoses and outcomes. In some studies, remission rates (percentage of patients with no evidence of active disease) have been as high as 60% when these drugs are used (Arthritis & Rheumatism Volume 52, Issue 1, pages 27-35, January 2005).

The standard of therapy at the present time is to institute therapy in rheumatoid arthritis patients as soon as within three months of the onset of symptoms; it has been demonstrated in clinical studies that most of the joint damage – and therefore the development of deformities and patients becoming crippled – occurs within 3-12 months of the onset of disease (Arthritis & Rheumatism Volume 54, Issue 3, pages 702-710, March 2006). To avoid delay in evaluation and treatment, we try to accommodate those patients with a presumed diagnosis of rheumatoid arthritis and an appointment within 3-4 weeks after contacting our office. These patients have to have a least one abnormal laboratory (either elevated rheumatoid factor or positive anti-CCP), swollen joints, and symptoms lasting more than six weeks. We understand the urgency of having these patients started on the right medicines as soon as possible.

Biologic therapy is also available for patients with psoriatic arthritis, lupus, and ankylosing spondylitis, other less common diseases, as well as children with idiopathic juvenile arthritis. These drugs do have potential side effects, one of the most important being that patients may be more prone to developing infections or having complications from infections. In future blogs, I will further address these issues, but for now I want to leave the reader with the knowledge of how beneficial these drugs have been to patients, especially those with inflammatory arthritides.

Adahli E. Massey, MD, FACR