Talking about changes to our autoimmune treatment can be overwhelming—especially if the conversation turns to biologics. Many people managing rheumatoid arthritis (RA) or other autoimmune diseases find themselves in a rheumatologist’s office, hearing that a biologic might be the next best step. So, what exactly are biologics, and how can you make the best decision for yourself? Let’s dive into the basics and explore some key questions to ask so you can feel more comfortable with whatever path you choose.
What Are Biologics?
Biologics are a class of medications that have brought a whole new level of specificity to autoimmune treatment. Unlike traditional drugs, biologics are made from living organisms—proteins, antibodies, or cells—which scientists isolate and modify to target specific aspects of the immune system. For people with autoimmune diseases, these medications can help reduce inflammation and limit the immune system’s overactivity that causes joint damage.
In RA, for example, one of the immune molecules often out of balance is TNF-alpha. So, some biologics are TNF inhibitors designed to specifically target this molecule. Rheumatology now has biologics for multiple conditions, from rheumatoid arthritis and lupus to psoriatic arthritis and ankylosing spondylitis. These biologics are generally administered as injections or infusions, which can seem daunting at first, but they are powerful tools in autoimmune treatment.
When does autoimmunity need a Biologic?
If your doctor brings up biologics, it’s likely because other treatments haven’t worked as hoped or have caused side effects. Rheumatologists have a guiding principle when treating autoimmune diseases: get inflammation under control as quickly and completely as possible. This strategy isn’t just about symptom relief; it’s also to protect long-term health, including your blood vessels, heart, and brain, from the harm that chronic inflammation can cause.
Sometimes, biologics are recommended even if your inflammation isn’t out of control right now. For instance, if your current medication is causing intolerable side effects or you’re dependent on prednisone, a biologic might be the next best option to maintain stability.
Key Questions to Ask
Making the decision to start a biologic can feel like a big commitment, and it’s completely normal to have questions and even doubts. Here are some important questions you can bring to your next rheumatology appointment to help you feel confident in your choice.
- “What markers are you using to decide that I need a biologic?”
It’s essential to be on the same page as your doctor about the state of your condition. Your doctor may point to blood tests or visible symptoms, such as swollen joints, as reasons for suggesting a biologic. Knowing these reasons can clarify why they think this step is necessary. - “What other options do I have, and why is this biologic the best choice right now?”
In most cases, there are multiple ways to approach treatment. While your doctor may feel that a biologic is the best option, understanding why it stands out over others will help you feel more informed and involved in the decision. - “What are the risks if I decide to hold off or not start this biologic?”
Sometimes, time is of the essence in autoimmune treatment, but in many cases, there may be room for careful consideration. Knowing the potential risks if you decide to wait or explore other options will help you weigh your choices.
Do you need the Biologic forever?
A common question I hear is, “Will I need to be on this forever?” It’s understandable to feel uneasy about long-term medication. The good news is that recent research has shown that, in certain cases, patients may be able to taper off biologics after some time. This depends on how well your disease is managed and the specific biologic you’re using. A good way to frame this conversation with your doctor is by asking, “Once I start this biologic, when can we discuss the possibility of tapering or stopping?”
Having these types of conversations upfront can help you feel more comfortable, making the decision feel less permanent.
Taking Time with Your Decision
Starting a biologic is a big decision, and you don’t need to make it on the spot. In many cases, you can take some time to think things over, align with your goals, and gather any additional information. It’s perfectly fine to request a follow-up phone call or a virtual appointment a few weeks later to discuss your decision and next steps.
Biologics can be life-changing for many people with autoimmune diseases like rheumatoid arthritis. While they’re powerful tools, it’s essential to understand why they’re being recommended and to ask questions that matter to you. With the right information and support, you can make the best choice for your health and feel confident about the path you’re taking.
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