If you have spinal inflammation, then you may have read about people taking biologics for ankylosing spondylitis, psoriatic arthritis, or other inflammatory conditions, and wondered if this kind of treatment could be right for you. Biologics belong to a class of drugs called disease-modifying antirheumatic drugs (DMARDs) that can treat a variety of inflammatory conditions, including various forms of arthritis.
If you have ankylosing spondylitis, for example, your back might be seized up with pain or stiffness every morning. (This particular form of arthritis causes chronic spinal inflammation, which can lead to back, hip, and neck pain, according to the Cleveland Clinic. Without treatment, the condition can even cause parts of your vertebrae to fuse together, making it hard to bend and move.) Depending on your particular diagnosis and situation, you might be able to take a nonsteroidal anti-inflammatory drug (NSAID) to relieve your symptoms, says Abhijeet Danve, M.D., rheumatologist and assistant professor of medicine at Yale School of Medicine. However, if those don’t help, you might consider taking other medications, including biologics for ankylosing spondylitis. (Keep in mind that your treatment options may change over time based on new research and newly available therapies. Make sure you have ongoing conversations with your doctor about which treatment options may be best for you.) In case it’s helpful to understand how biologics may work for you, here’s what you should know.
1. Biologics are really targeted treatments.
With autoimmune conditions that cause inflammation, like ankylosing spondylitis or psoriatic arthritis, your immune system mistakenly attacks healthy cells in the joints of your spine. To help counteract this, biologic medications target the very specific part of your immune system that contributes to inflammation and tries to prevent it from triggering an overactive autoimmune response.
Your doctor may recommend a specific form of biologics called cytokine inhibitors if your condition doesn’t respond well to treatments or hasn’t been well controlled until this point. There are two kinds of biologics commonly prescribed to people with spinal inflammation:
- TNF inhibitors. Also known as a TNF blocker, this type of biologic blocks a protein called TNF, which drives inflammation in diseases like ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis. There are several TNF inhibitors, and they all work a little differently, so if one doesn’t work for you, your doctor might suggest trying a different one.
- IL-17 inhibitor. This kind of drug prevents molecules called inflammatory cytokines from signaling specific immune cells to create inflammation.
Notice how both drugs are considered inhibitors. That’s because they’re interfering with a process that’s causing the inflammation that’s giving you trouble. In other words, they’re blocking the action that’s causing your stiff, sore back and hips.
2. Biologics are injected and infused.
It’s important to know that biologics are administered by infusion or subcutaneous injection, so they can be a little more involved than just taking a pill.
With infusions, you’ll need to visit a hospital or clinic for your treatment. The process can take a couple of hours, and you can listen to a podcast, read a book, scroll through emails on your phone, or just rest during this time. “Some patients find it relaxing,” Alexander Geevarghese, D.O., rheumatologist at Northwestern Medicine Central DuPage Hospital, tells SELF. Some hospitals or health-care organizations also offer home infusion programs, in which a nurse comes to your house and administers the medication to you. If you have a very inconsistent schedule or you travel a lot, consider talking to your doctor about whether infusions are right for you. The frequency of infusions varies depending on your specific medication, and your doctor can help you find something that fits your lifestyle.
Injectable biologics are self-administered at home, so they require you to be more hands-on unless you have a family member, roommate, or friend give you the injection. Otherwise, you can self-administer the medication, which many people store in their refrigerators since it must stay chilled. One benefit of using injectables is that you can take the medication with you on trips, as long as you store it in a cooler or use ice packs to keep it cold.
If you’re anxious about using needles, know that people often become more comfortable giving themselves shots with time, according to Ellen Gravallese, M.D., chief of the division of rheumatology, inflammation, and immunity at Brigham and Women’s Hospital. You may want to ask your doctor if someone in their practice can help you administer your first shot. (Some medical offices will allow you to schedule an appointment with a nurse to practice injections.)
3. Biologics have various potential side effects.
Because biologics target only parts of your immune system, as opposed to your entire immune system, you may have fewer side effects than you would with oral immunosuppressive medications or drugs. With that said, every medication has a potential for side effects, and biologics are no different. The side effects can and do vary from drug to drug. Drug labels can be a little overwhelming to read when you’re starting a new medication, so don’t be afraid to ask your doctor about side effects. Your clinician won’t always know how a specific medication may affect you, but you can ask about common side effects experienced by their other patients.
Reactions at the infusion or injection site are generally the most common biologic side effects. You might notice some redness, pain, swelling, or even some itching at the spot on your skin where the needle went in. This kind of reaction is typically mild and benign, according to Maximilian F. Konig, M.D., rheumatologist and instructor in the division of rheumatology with the Johns Hopkins University School of Medicine.
Additionally, you may be more vulnerable to infections because biologics suppress your immune system. If your doctor doesn’t bring this up, then you may want to ask whether it’s helpful to take any particular precautions to reduce your risk of getting contagious illnesses.
4. Biologics take time to work.
Every medication is a little different, but generally speaking you might notice symptom improvements within weeks of starting a biologic, according to Dr. Geevarghese. However, it could take several months before you really benefit from taking this kind of medication.
The response time varies from person to person, according to Abin Puravath, M.D., a fellow in clinical and molecular rheumatology with the Johns Hopkins University School of Medicine. “Some patients experience dramatic symptomatic improvement within days, while others take much longer to achieve an improvement or resolution of their symptoms,” Dr. Puravath tells SELF.
You may find that keeping a journal of your symptoms (including how you feel, how often you experience symptoms, and when your symptoms occur) may help you better understand your response to a medication.
5. Finding a biologic that works for you can take time.
At some point on your biologics journey, you might start to wonder if you will find the level of pain relief you were hoping for. Let your doctor know if your symptoms haven’t gotten to a manageable point within six months of taking your medication, advises Dr. Danve. He says he assesses whether a biologic is right for someone after about three months. You may need to try several different biologics to find one that’s effective for you.
Once you and your doctor have found a drug that helps you achieve good control of your disease and you feel better, you could keep receiving it indefinitely (as long as it continues working). The goal of treatment is to achieve remission of your symptoms and to reduce inflammation, which should hopefully reduce how the disease affects your ability to do all the things that you want to do. As long as you tolerate the drug and it works for you, you could take the same one for years.
Even though the process can take some time, finding a treatment plan that works for you can be worth the effort. Your life can significantly improve when your pain doesn’t affect every part of your day.
Sources:
- Stat Pearls, Disease Modifying Anti-Rheumatic Drugs
- Indian Journal of Dermatology, Biologics: Target-Specific Treatment of Systemic and Cutaneous Autoimmune Diseases
- Cleveland Clinic, Corticosteroids
- U.S. Food & Drug Administration Information on Tumor Necrosis Factor (TNF) Blockers
- Dermatologist, Biologics in Practice: Managing Common Side Effects
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