What to Ask Your Doctor Before Starting a Biologic for RA
Learning I had rheumatoid arthritis (RA) came with an entire mixed bag of emotions.
To be honest, I was really grateful to have an explanation about the severe joint pain, elevated inflammation markers, and other symptoms I’d struggled with over the years. Labeling it gave it a definitive outline, and allowed my doctor and I to discuss and then create a targeted treatment plan.
Grief and concerns for the future
On the flip side, I needed some time to grieve the overwhelming sadness that came along with my diagnosis. There is currently no cure for RA, meaning that this disease will affect me forever and I immediately wondered how my body would look and feel as I aged.
I was 30 years old when I was diagnosed, and I feared for my mobility in the future. Would I experience a significant increase in pain, decreased flexibility, and/or further joint damage? Was there medication available at that point (or would there be in the future) to help manage my health and treat my symptoms?
Starting treatment to get symptoms under control
My rheumatologist explained that due to my moderate to severe level of disease activity, she was recommending I start a biologic medication as soon as possible. She felt that this had the highest likelihood of getting my symptoms under control, managing my pain and preventing increasing joint damage. I felt grateful for the aggressive plan, but I had a lot of questions.
What is a biologic?
She explained that a biologic medication is a powerful medication developed from living cells such as a microorganism, or plant or animal cells. This differs from other medications/drugs that are manufactured via chemical synthesis. Biologic drugs are used to manage and treat several diseases and conditions, including autoimmune-related diseases like RA.
Unlike other types of medication prescribed for RA, biologics focus on preventing additional joint damage by blocking specific substances in your immune system which, in turn, reduces your arthritis-associated inflammation and pain.
In need of a medication to treat RA and Crohn's
I agreed that it felt like the best course of action moving forward. And, coupled with the fact that I was already living with Crohn’s disease, I knew I’d need medication that could manage both conditions for the long-term.
Questions to ask your rheumatologist
After 4 years and 4 biologics, I’ve put together a list of questions I recommend asking your rheumatologist or prescribing physician when they suggest a biologic for your RA.
Things to ask your provider before starting a biologic:
1. Is a biologic the best choice of medication for me? Why?
2. How will this medication be administered? Where will it be administered? (ie: If it’s an infusion medication, find out where your options are to sit for the infusion.)
3. What are the risks of this medication? How can I manage them?
4. What are the potential side effects of this medication? How can I manage them?
5. Does this medication interact with any of the other medications or supplements I take?
6. If this option feels uncertain to me, what other choices would you suggest?
7. Is this medication safe for pregnancy or breastfeeding? (if that’s of interest to you now or in the future)
8. How long will it take before I see/feel a benefit from this medication?
9. At what point would we consider this medication a “failure” and try another option?
10. How can I communicate with you about changes, side effects, and other symptoms?
11. Will you do any routine blood work once I begin this medication?
12. Is there a patient assistance program for the cost of this medication? How can I find out more information about it? Can someone on your staff assist me with this?
Be prepared before starting treatment
Asking all of your questions before beginning any new medication, let alone a biologic, is so critical to your comfort and success with a new treatment plan. Additionally, connecting with other patients who have been on that medication can help support you by learning about patient perspectives and recommendations. Our Q&A section and patient forum are so helpful for that!
Finally, I've learned after all this time that if something doesn't feel right, it's imperative to speak up. The first biologic I was prescribed for RA caused a really frustrating side effect. Although my doctor was sure "it was something else," when the medication finally left my system so did the corresponding problems.
If you're new to biologics, comment below with any additional questions you have or what you found helpful to ask your doctor about! If you've been on biologics in the past, I'd love to hear what you'd add to my list above!
After the past 2+ years, how do you feel about telehealth appointments to manage your RA?