How Your RA Body Feels on Biologics
Here's what to expect when you start biologics for RA — straight from people who take them and some medical experts, too.
For Eileen Davidson,33, biologics are life. Without this medication, she struggles to walk up a flight of stairs. Or stay awake until her 6-year-old son, Jacob, goes to bed. Or just function at all.
Davidson recently had to stop her生物治疗for rheumatoid arthritis (RA) prior to a minor a surgery, and the difference is significant.
“The simplest of tasks are difficult to do because of fatigue and flares,” says Davidson, who shares her patient experience on her blog, Chronic Eileen.
With the help of her medication—which is Actemra (tocilizumab)—she’s able to “handle some of the smallest things a healthy person would normally take for granted.”
但是，戴维森在不列颠哥伦比亚省温哥华（不列颠哥伦比亚州温哥华），并于2015年被诊断出患有RA（她也有骨关节炎或OA），也没有在生物学中最容易的时间。她经历过睡眠障碍，增加了抑郁症，恶心，胃疼痛。
所有生物学，是大量蛋白质抗体，其靶向导致Ra的炎症反应，并通过......
Infusion (IV)
Injection
与大多数药物一样，生物学通常具有长期副作用的长期效果。他们也是强大的治疗师。
The key is finding the right balance. “Biologics are generally more effective in treating RA symptoms than non-biologic medicines, and even in some cases, safer,” says Justin Peng, M.D., a rheumatologist at Arthritis and Rheumatism Associates in Washington, D.C.
“As with all medications, the risks and benefits should be discussed with the doctor so that the best treatment program can be developed for the individual patient.”
目标总是呢？尽可能地减少你的RA活动。And when you know how biologics might make you feel—both positively and potentially not so—you’ll be better able to navigate any pitfalls and make smart changes to get you where you need to be.
Side Effects of Biologics (and What You Can Do About Them)
副作用包括但不限于这些（按大部分最少的顺序）：
Infections
Irritation at the injection site
head
Nausea
Allergic reaction
Heart failure (but only in those with prior heart disease)
Increased risk of certain types of cancer
Yes, some of these side effects are scary, including the possibility of cancer (“although studies are mixed and a causal relationship has not been proven,” Dr. Peng says). But biologics are worth your consideration even with these potential risks, he says.
让我们更详细地走过两个最常见的副作用。
Infections, to start.
“These medicines are all working to suppress the immune system in a way that then translates into reduced inflammation and better quality of life,” says Brian Horgan, P.A.-C., a board-certified physician assistant at Tri-State Pain Institute in Erie, PA, a comprehensive pain- and arthritis-management center.
As a result, your body has fewer defenses against common viruses and bacteria. Published data suggests the risk for infection is higher in some populations than others: In ananalysisof 5,596 patients on biologics with inflammatory chronic arthritis (including RA) or psoriasis, 4.2% (or 289 people), had infections severe enough for hospitalization.
老年人的风险更高or those with comorbidities. The most common infections were in the upper and lower respiratory tract—so basically,colds, sinus infections, pneumonia, and bronchitis.
戴维森感冒了，她无法在她的第一个生物学，鬣狗（阿巴木钱）上震动。虽然在第二个Orencia（AbataCept），但她开发出严重的盆腔感染。
为了降低生物学的感染风险（并且通常也是一般），你不必做得超过通常的事情。彭博士推荐：
Washing your hands regularly
Avoiding anyone sick
避免可能含有有害细菌的生或未煮熟的食物
Having vaccinations (but consult your doctor on this one first because with the lower immunity that biologics bring, certain live vaccinations may be safer to have before you start treatment)
Irritation at the injection side, next.
According to the Arthritis Foundation, these injection-site reactions can be “fairly common,” often when starting treatment with biologics (they're less common for infusions, which are delivered through an IV).
This happened to Cathy Kramer, 51, who lives in Naperville, IL. She now injects Enbrel (etanercept) in her thigh after she developed an itchy rash on her stomach. Amgen, the company that makes Enbrel, lists injection site reactions as a common side effect (and the Arthritis Foundation notes that side effects labeled as “common” occur in 1 in 10 who take a drug).
“A local injection-site reaction is typically associated with a tissue irritation response surrounding the area where the medication was administered,” says Horgan. “Local reactions usually resolve within a few days. This is different from an anaphylactic or systemic allergic response, which can have serious implications.”
Here are some tips for reducing injection-site issues (which are “easily treatable”) before injecting a biologic, according to Dr. Peng:
Ice the area
Use a topical agent, such as topical lidocaine (but be sure to discuss with your doctor first)
Bring the injectable up to room temperature
How Will You Likely Feel on a Biologic?
Here’s the deal: Biologics can be “miracle drugs,” but like any other medication, they’re not perfect, says Horgan. So while you may think all of your symptoms will stop, it could be that they quiet down but with an occasionalRA flare。
对于克拉姆人，她的喇叭子在没有生物学的几天内持续数月。那些耀斑现在更容易管理。她能够在当地社区学院的支持人员全职工作，在生物学之前，她无法完成。
“我肯定知道我有类风湿性关节炎。它不像just magically disappeared,” Kramer says. “For the most part, I have flares occasionally, but usually it’s when I overdo things, or I’m letting myself get bogged down with stress, but they’re very short, and they’re nothing like what I had in the past, before getting on this biologic.”
她的手指仍然僵硬，她的膝盖偶尔会膨胀，但她可以处理这些症状。
“I feel normal again. It’s just being able to live my life again,” she says.
A good response to a biologic (and the goal of treatment) is remission, Horgan says. So you could potentially expect:
减少刚度，肿胀的关节和疼痛
Improvement in range of motion and level of functioning
Increased activity tolerance and quality of life
Reduced inflammatory-marker activity in blood work and stabilization of joint disease progression on X-ray
“Biologics are a big piece of a puzzle made of many pieces of a patient’s treatment program,” he says.
如果你的生物学不是减轻你的症状 - 或者正在增加你的副作用 - 你的医生可能会把你送到另一个。其迹象不起作用包括不良事件，即不会消退，没有症状浮雕，或者您开发自己的抗体，在停止炎症时不再有效（您的医生可以测试）。
Davidson is currently on her third biologic after experiencing intense side effects with the previous two. But the trial and error has been worth it. Prior to starting biologics, she tried 18 drugs total for RA, including methotrexate, the标准DMARD, or disease-modifying antirheumatic drugs. She didn’t respond well to that药物，体验强烈的副作用。
“我很难打扰感染，我真的很麻烦，有腹泻，”她写在她的博客上。“一些药物我只能在几周内，因为他们造成了这种严重的抑郁和情绪在我身上摆动。”
“当我准备开始生物学的时候，我害怕毒品，我避开了他们和我的风湿病学大约六个月，”她写道。
Now, she feels so much better on a biologic. She can write. She can keep up with her son. And she can be a patient advocate, serving as ambassador for the Arthritis Society and an Arthritis Research Canada Patient Advisory Board member.
Finding a biologic that has little to no side effects for her has meant everything to Davidson, because in addition to having reduced pain and reduced damage to her joints and organs, in the last two years she’s been on Actemra, she feels “more in control of my disease.”
When Will You Feel Better?
You’ll likely experience results, or a response, from a biologic within a few weeks, or up to about three months of your starting dose. “While the effectiveness of biologic agents varies, I usually tell them to be patient,” Horgan says.
他注意到，最好的结果通常发生在组合治疗中，例如生物药剂和甲氨蝶呤。
2004年诊断为RA的Kramer一直在嵌入式（第一次生物学），近10年，但她仍会记住她在开始药物的几周内如何改善她的症状。
“了解很多人没有良好的结果，我不希望任何人预期立即结果，”她说。“然而，我觉得我有一个乐观的观点进入它。我也意识到这个可能会结束，我会尝试另一个。ra是一个过程。“
一旦你在生物学，你可能会每三个月左右看到你的医生，让你的回复（和可能的副作用）监控。You’ll typically have blood work done at those visits, to test your levels like inflammatory markers and blood-count abnormalities, according to Dr. Peng, which can measure for the effects of long-term use of medication and infections, among other issues. These tests will help your healthcare team monitor your body’s ongoing reaction to the drug.
Be sure to call your healthcare team if you experience any side effect outside of those regular visits—even if you’re not sure your symptom is related to your medication. It’s better to be proactive when on biologics than to run the risk of your condition worsening, he says.
In Horgan’s community-based practice, he might see a patient more often than every three months if they have issues with their RA that won’t stop, like residual pain and inflammation, or musculoskeletal issues, such as tendonitis or bursitis.
Davidson had something similar happen. She tried Actemra for six months to see if it lessened her RA symptoms, but she was still experiencing pain, and was concerned it might be a flare.
So she got a second opinion and an ultrasound, which showed her that the pain was actually permanent joint damage from RA and OA—her new biologic wasn’t the issue.
“I felt relief knowing I was on the right treatment path, keeping the inflammation at bay,” she says. “The more I understood my disease and limitations, the more I could see how Actemra was working for me overall, and I couldn’t be more grateful for advances in modern medicine.”
yumhee公园的额外报告。
