Along with a diagnosis of rheumatoid arthritis (RA) comes many questions and concerns, especially when it comes to treatments. While there is no cure for RA, you can manage its symptoms. 

Two of the most common medication options for RA symptoms are conventional disease-modifying antirheumatic drugs (DMARDs) and biologic medications. Both help control RA, reduce inflammation, and protect joints from long-term damage, but they work differently.

Understanding the difference between DMARDs and biologics can help you have a more informed conversation with your rheumatologist about which option may be right for you.

What Are Conventional DMARDs for Rheumatoid Arthritis?

Conventional DMARDs are medications that slow the progression of RA rather than just relieving pain and stiffness. They work by modifying immune activity, reducing inflammation and helping prevent joint damage. DMARDs are often the first treatment prescribed for people diagnosed with rheumatoid arthritis.

Common DMARDs include:

• Methotrexate: Often the first-line treatment for RA, methotrexate reduces inflammation and slows disease progression.
• Hydroxychloroquine: This medication helps control inflammation and is often used for milder RA conditions or with other DMARDs.
• Sulfasalazine: This medication helps reduce inflammation. It can be used alone or alongside other RA treatments.
• Leflunomide: Leflunomide suppresses certain immune activities involved in inflammation and helps to slow joint damage.

Conventional DMARDs are generally oral medications (though some can be injected). It may take several weeks to a few months for RA patients to realize the full effects of the medication. Your rheumatologist may monitor your symptoms and order blood tests to evaluate your response to treatment and check for side effects.

What Are Biologic Medications for Rheumatoid Arthritis?

Biologic medications are a type of DMARD made using live cells or biological processes. Rather than broadly affecting the body’s immune response, biologics target specific proteins, cells, or pathways involved in the inflammation that causes RA.

By blocking the inflammatory signals, biologic medications can reduce joint swelling, pain, and stiffness while also helping to prevent further joint damage.

Biologic medications used to treat RA include:

• TNF inhibitors: These medications block tumor necrosis factor (TNF), which is a protein that contributes to inflammation.
• Interleukin inhibitors: These medications target specific interleukin, immune system proteins involved in inflammation.
• T-cell costimulation modulators: These help interfere with the activation of certain immune cells involved in RA.
• B-cell-targeting medications: These medications target B cells, which play a role in the immune response associated with RA.

A rheumatologist may consider biologic medications when conventional DMARDs don’t adequately control the disease or when a patient’s disease activity and clinical circumstances may require a different approach.

Biologics may be given as an injection under the skin or through an intravenous (IV) infusion. Some patients notice an improvement within a few weeks, although the time to achieve the full benefits of biologics varies.

What are the Risks and Side Effects of Each Treatment?

Both conventional DMARDs and biologic medications can cause side effects. Because they affect immune system activity, both may increase the risk of certain infections.

Conventional DMARD side effects

Potential side effects depend on the specific drug, such as:

• Methotrexate may cause nausea, mouth sores, or liver abnormalities. It requires regular monitoring and must not be used during pregnancy.
• Hydroxychloroquine may cause retinal damage, though it’s rare. Therefore, regular eye examinations are recommended.
• Sulfasalazine can cause gastrointestinal symptoms or a rash.
• Leflunomide may cause liver problems or changes in blood pressure. It also has pregnancy-related precautions.

Your rheumatologist will consider your medical history, other medications, and individual risk factors when selecting a conventional DMARD.

Biologic medication side effects

Potential biologic medication side effects include injection-site reactions, infusion reactions, and an increased risk of certain infections. Specific biologics also carry risks related to the immune activity they target.

Your rheumatologist may screen you for tuberculosis and hepatitis B before starting a biologic medication. They may also review your vaccination status and recommend certain vaccines before beginning treatment.

Careful screening and ongoing monitoring helps to balance the benefits of biologics against potential complications.

How Do You Know Which RA Medication is Right for You?

No single RA medication works for everyone. Your rheumatologist will consider factors like disease severity, other health conditions, and your treatment preferences-such as oral pills versus injections-to help determine the best option for you.

Your rheumatologist may start with a conventional DMARD and closely monitor your response. If needed, they may adjust your treatment plan, including options like biologics, to ensure your RA is effectively managed.

Find the Right RA Treatment for You

Living with rheumatoid arthritis can make every day feel like a struggle. However, treatments can help control inflammation and protect your joints. Conventional DMARDs and biologic medications both play important roles in RA treatment, and understanding their differences can help you make informed decisions about your care.

Our team at Advanced Rheumatology of Houston can evaluate your symptoms, discuss appropriate treatment options, and create a personalized treatment plan based on your needs and health goals.

If you are living with RA, contact us to discuss your treatment options. Early diagnosis and appropriate disease management can help protect your joints and enjoy a better quality of life.

Frequently Asked Questions

1. Why would a doctor start with a conventional DMARD instead of a biologic?

Doctors often start rheumatoid arthritis treatment with a DMARD because it can effectively control the disease, has a well-established safety record, and is usually less expensive than a biologic medication. However, the decision depends on RA activity, the patient’s medical history, and other individual factors.

The important thing is not which medication category you start with, but whether your treatment is controlling your RA.

2. Are biologics more effective than conventional DMARDs?

Biologic medications can be more effective than conventional DMARDs for some people with RA, particularly when conventional treatment hasn’t adequately controlled the disease. But this doesn’t mean that biologics are better for everyone.

The key difference is how well a medication works for a particular patient, not simply which category it belongs to.

3. Can someone take a conventional DMARD and a biologic at the same time?

Yes, many people with RA take a conventional DMARD and a biologic medication at the same time. In fact, combining these treatments is a common strategy when one medication alone doesn’t adequately control the disease.

The right combination—or whether you need combination therapy at all—depends on your individual circumstances.