When should biologics be started for rheumatoid arthritis?

Question

Hello doctor,

I am a 45-year-old woman living with seropositive rheumatoid arthritis for six years. Despite Methotrexate and Hydroxychloroquine, I still have joint stiffness and swelling in my hands and knees. My erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) remain elevated.

How do doctors determine the right time to start biologics or Janus kinase (JAK) inhibitors, and how do they decide between different options?
Are there non-drug approaches, like physical therapy or diet, that meaningfully reduce inflammation and disability?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I would like to help you navigate through your doubts. Rheumatoid arthritis can feel overwhelming at first, but with the right guidance and support, it can be managed well over time.

As doctors, we have a wide variety of medications to choose from while treating a patient with rheumatoid arthritis (RA). We look into several factors like general health, clotting profile, past infections, skin or bowel disorders, inflammation levels, and patient affordability.

These factors together help us arrive at the most suitable treatment plan for each individual.

For example, for patients with high inflammation, we prefer tumor necrosis factor (TNF) blockers. For patients with skin lesions or bowel disorders, we prefer interleukin-6 (IL-6) inhibitors.

Janus kinase (Jak) inhibitors are an upcoming group of drugs with the advantage of having oral preparation, with the disadvantage of cost and clotting disorders. So, we weigh our options accordingly based on what suits each patient best.

Non-drug approaches have only add-on benefits in rheumatoid arthritis (RA), and the primary treatment remains drugs.

Having said that, it is a good practice to engage in strengthening exercises, light aerobic activity, joint mobility, and range of motion (ROM) exercises.

Living with rheumatoid arthritis (RA) requires patience and consistency in following the prescribed plan. Having a balanced diet and incorporating fruits, vegetables, and omega-3 fatty acids in the diet is good.

Weight management helps in the long run and contributes positively to overall joint health and daily well-being.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.