Can Biologics relieve my rheumatoid arthritis symptoms?

Question

Hello doctor,

I am 35 years old and have rheumatoid arthritis that has been difficult to control. I was on Methotrexate for almost a year, then switched to Leflunomide because my joints were still swollen and painful, but neither medicine has given me enough relief.

My rheumatologist mentioned biologics during my last visit, and I have been wondering: can Humira help when Methotrexate and Leflunomide both failed at 35? My hands are becoming stiffer every morning, and I am finding it harder to keep up with my job. I do not know what to expect if I start a biologic or whether the benefits usually outweigh the risks.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Biological therapy is the next step in managing rheumatoid arthritis if conventional therapy, such as Methotrexate or Leflunomide fail. They are much stronger medications, working mostly on the small molecules causing the inflammatory process, giving better results.

Considering we have a difficult-to-treat rheumatoid arthritis with poor response to conventional therapy and in a young patient, being more aggressive earlier with biological therapy is a much better option than further waiting, as the above factors are all poorly prognostic and the disease can cause irreversible erosions and deformities if left untreated properly for a longer time than that.

These drugs are mostly safe. As long as you exclude any infection, especially tuberculosis or viral hepatitis, and you continue to monitor your vitals and laboratory workup every 4 to 6 months, then you can rest assured their benefits far outweigh risks.

The investigations to be done before starting biological therapy include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine, hepatitis C virus antibody (HCV Ab), hepatitis B surface antigen (HBsAg), human immunodeficiency virus antibody (HIV Ab), tuberculin test, chest X-ray, and hand X-ray.

The treatment plan is to start biological therapy along with Methotrexate 25 mg once weekly. Leflunomide should be stopped once the biological agent is initiated. Prednisolone 20 mg daily should be continued for two weeks until the biological therapy starts to work, followed by gradual withdrawal by 5 mg every 10 days until reaching 5 mg daily.

Follow-up is recommended after three months of biological therapy. Rest and cryotherapy are advised as preventive measures.

I hope this helps.

Thank you and take care.

Regards.