Do biologics slow down the progression of arthritis?

[Celticdancer]

I was wondering if there is much research to show that biologic drugs slow down the progression of arthritis or if they have no effect? Some research articles I've read about biologics say they slow down progression of disease in up to 50% of patients if caught early in the disease and others say they have no effect on slowing the disease.

[charisma]

It is different for everyone, Celticdancer.Biologics are not offered first, in the UK as they cost so much; got to try Methotrexate etc and if two or more (depending on your local NHS Health Board) fail you, then you’d be offered biologics in some form.

The injections of Amgevita failed me. I was urgently prepared for Rituximab and after a six years and seven months struggle, RA has been subdued effectively for almost a year now.

So that drug infused every six months (three lots of two infusions) sorted mine so far. Fingers crossed 🤞

[AgedCrone]

Well Rituximab has slowed my disease to almost full stop…. I didn’t start on it until almost 20 years after I was first diagnosed….so certainly not early in the disease. It was like night & day…& now I only need an infusion every 7/8 months, no other drugs needed, & I feel so much better.

I am indeed one of the very lucky ones…. But I for one am proof positive …..biologics certainly do make a big difference.

[Twitty999 in reply to AgedCrone]

Me too AgedCrone,😊. I’m so thankful for it! But my journey has only been 4 years. I have only been having a single dose during Covid and it is still lasting at least 7 months up to now & hopefully not reducing my immune system so much 🙏🏻 x

[Neonkittie17]

If you get the right biologic working great for you, then most definitely YES. I had 8 years of being RA pain free and no inflammation or raised CRP. What the biologics can’t do is repair old, prior osteo/joint damage and stop that pain. Good luck.

[Deeb1764 in reply to Neonkittie17]

Wouldn't it be lovely if biologics helped OA pain!

[Neonkittie17 in reply to Deeb1764]

It would be amazing if they could make a treatment to do both. 🙏🏻

[Hidden]

With the caveat that I’m not remotely medically qualified, and this is just my own understanding…

I’m not sure about the papers you’re reading if they’re suggesting biologics don’t slow progression. With the exception of steroids, the whole point of any systemic medication in arthritis is to slow - if not stop - disease progression as much as possible. As I understand it, disease progression is generally considered to be any permanent joint and organ damage that occurs as a result of the autoimmune driven inflammation being active and not controlled. Conventional DMARDs and/or biologics are given in an effort to get the inflammation under control, at which point the disease progression is halted or slowed because the inflammation isn’t present to cause the permanent damage. When inflammation is under control, and in joints where there is little permanent damage or deformity, symptoms like swelling and pain etc. are minimised if not completely absent. Wider issues like fatigue and brain fog are also (mostly) in check. So, my understanding is that if symptoms are significantly improved as a result of DMARD or biologic medications (or even absent completely), this is the direct result of the disease progression being slowed.

Really, the big problem in managing arthritis is that what works for one patient doesn’t necessarily work for another, so some people will respond really well to certain medications, others won’t, and we still can’t predict or understand why. But the bottom line is that biologics wouldn’t be used to manage arthritis if they weren’t capable of slowing disease progression: in the absence of suppressing inflammation, they’d just be a very expensive waste of time and of no more benefit than steroids, which is why you’re usually quite quickly moved on to a different one if you don’t respond.

Here are some of the papers I’ve read on the efficacy of biologics over the last year or so that support the above:

ncbi.nlm.nih.gov/pmc/articl...

futuremedicine.com/doi/10.2...

academic.oup.com/rheumatolo...

[AgedCrone in reply to Hidden]

Right on Charlie…..I cost the NHS hardly anything these days….OK, my infusions are expensive…but I am down to one every 7/8 months, rather than 4 per year. Apart from the odd analgesic when my joints decide to misbehave…usually because of over exertion …My condition is much more stable, since being prescribed a Biologic.Joint damage prior to Biologics does not disappear….but I find it less troublesome.

However- Rheumatologist doesn’t just throw any old biologic at a patient…. they are chosen for a persons individual circumstance….& it is not an exact science….hence just like a non bio Dmard, many people are not successful on their first Biologic…but it is certainly worth persevering if you are offered them.

[Mmrr in reply to Hidden]

😎

[Hidden]

Wow you explained that very well 👏

[Twitty999 in reply to Hidden]

Yes… & I totally agree 😊

[Brushwork]

Biologics can be a wonder drug, silver bullet if and while they work for you. Perhaps the key thing here is that they slow or stop RA progression for as long as you take them and your body tolerates them and if you have been lucky to find one that works for you. RA returns and progresses if treatment is stopped or your body finds a way to either reject or circumvent it.

[Runrig01]

Have you looked on the NASS website, they have several research papers covering the subject. It is individual in each case. I was late being diagnosed, I was diagnosed by a Nass medical adviser, who went through my mri in detail. She explained I had several areas of fusion including SI joints and ribs, but said it was aggressive and needed urgent biologics to slow it down. That was in 2016, I had another scan a year ago, which showed no further damage and minimal inflammation. At the end of the day, if they didn’t slow progression, they wouldn’t use them, as they would then be a very expensive painkiller. The cost is around £12,000 a year. You have to be seen to be benefiting from them if they are stopped. At the end of the day, for the time being this is the best treatment for AS, so having something is better than nothing.

This paper doesn’t state how much progression is slowed, but concluded they do slow it down. As I say there is a number of research papers on the Nass site covering the topic.

rheumatologyadvisor.com/hom...

[Sunset54]

I have been on etanercept for over 20 years with methotrexate injections too. For me it has been a life saver.

[KittyJ in reply to Sunset54]

Wow, you just have been one of the first people to use it.

[CagneysMum]

Amgevita (biologic) in tandem with methotrexate and hydroxychloroquin has been a game changer for me and has given me back my life. I spent Thursday this week walking/sight seeing all around London with a friend and lost count of the number of tube stairs I walked up and down. 3 years ago I needed a wheelchair to help me get around and was struggling to walk even a few steps. I ached a little yesterday and felt more tired than usual but no pain. 😁

[Mmrr]

You have some wonderful answers above. I was simply going respond, yes, they do slow down or stop disease progression, depending on how effective they are for the individual. In today's RA world we rarely see the disfigured joints to anything like the extent we did in the past, pre MTX or pre advanced therapies becoming available.

By controlling inflammation, joints (and organs) are protected from long term damage, that is the aim.

[Hidden]

I thought/think that if the inflammation in your body is slowed down then surely the effect of RA on your body will diminish too/? My T cells are depleted with my biologic -which are over the top when I don't have a biologic so I guess my body is not over reacting with RA now.

However the damage has been caused and is none retrievable to my bones and joints, tendons etc. over the years when because of side effects of RA medicines I had to do without whilst waiting for my next medicine to try.

[oldtimer2]

About five years ago I went to an 'alternative' living place in West Wales for a dance event. At the event was a man who looked very elderly and crippled with arthritis who, with some difficulty with his disorted joints, was playing a drum with the musicians. I talked to him in a break and discovered that he was in his fifties and had Rheumatoid Arthritis and he had refused conventional treatment. I was, quite honestly, horrified at his distorted joints and his obvious pain.

I thought then, and do now, thank goodness for modern medicine! Otherwise I would be like him, crippled. And I do rather vaguely remember my grandmother who had RD and was in a wheelchair with horribly disorted hands but who died when I was very young.

[helixhelix]

Just to say we are talking about inflammatory arthritis, not osteoarthritis. My biologic has done wonder for my IA and sweet nothing for my OA.

[Mmrr in reply to helixhelix]

Yes, same here.

[mmb50]

I take etanercept , Methotrexate and Hydroxychloroquine. Without etanercept the others weren’t really helping but the biologic was a game changer. I’ve been on antibiotics for a few weeks so not taking any of the above and I’m noticing joint pain I had forgotten I had prior to biologic. So a big 👍👍 from me. I hope if trying biologic it will be great for you. X

[Angels54]

Yes biological are used to slow down the progression of RA.

[chunkypie]

I take adalimumab for psoriasis and i also have arthritis. All i can say is the adalimumab pretty much reversed and cleared my arthritis. I had "Sausage fingers" and now they are normal. yes i still have the odd bad day but i cant still do a physical job and carry on as normal.

[Bethany02]

I worked in Rheumatoid wards as a junior nurse and remember how crippled they were to the point of being unable to feed themselves so when I got my diagnosis I was so scared. The nurse specialist helped me to understand the importance of drug therapy and the progressive changes they had made in the last few years. I failed methotrexate as my liver didn't like it at all and then went onto benepali (etanercept). I knew a lot of these drugs because I worked with them and was also a bit wary of using them in a well setting but could see how they worked as in supression of the immune system to stop damage. Obviously all drugs including paracetamol have side effects but when it comes to quality of life I'd rather take a little risk than the pain I was in prior to starting with multiple flares which made me unable to function. There is chat just now of something else which will actually cure the immune reaction to self but that will be the future hopefully till then the immune supressors are definitely worth it based on the patients I seen 40 years ago