Biologic agents in inflammatory arthritis

Abstract

The term ‘inflammatory arthritis’ (IA) encompasses a spectrum of diseases, of which the most common forms are rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Over the past decade, the advent of immunomodulatory biological therapies has dramatically changed the management of such diseases, and offers alternatives for patients with a poor response to the more conventional disease-modifying anti-rheumatic drugs (DMARDs). Over recent years, more emphasis has been placed on the concept of shared care between specialist and primary care physicians for many chronic conditions once on a stable treatment regime, in order to improve hospital workload and enable more flexibility for patients. This brief review highlights the key points relevant to primary care physicians involved in the care of patients with IA on biologic agents. Immunomodulatory biologic agents (Table 1) are proteins derived from human genes that are genetically engineered to inhibit precise components of the immune system.1 By doing so, they suppress specific pathways that play a pivotal role in IA pathogenesis and, hence, differ from the more commonly used DMARDs, which have broader targets.1 If tolerated, biologic agents are used in combination with methotrexate, or an alternative DMARD, in view of enhanced efficacy. View this table: Table 1. Summary of biologic agents licensed for …