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Biologics are proteins that are genetically engineered to target specific parts of the immune system that affect inflammation. Each one zeroes in on a particular cause of inflammation and either tamps it down or turns it off completely, or shores up certain immune system components that fight inflammation. Biologics can slow joint damage significantly or actually bring it to a halt.

While they can be used alone, all of them work better in combination with DMARDs such as methotrexate. Two biologics should not be used together. Biologics are quite expensive because they must either be injected or infused. Generally speaking, they take about three months to start working, although some people start to feel better sooner.

Many different types of biologics exist:

 Tumor necrosis factor (TNF) inhibitors (Humira, Enbrel, Simponi, Cimzia, Remicade): All but Remicade are injections given anywhere from once a week to once a month; Remicade is an infusion. Since they have been around the longest, these are typically the first type of biologic used when DMARDs alone fail to provide adequate relief.When TNF inhibitiors fail, there are several other types of biologics that can be tried next. Which drug is chosen will depend on the patient’s health, personal preferences, and insurance coverage.

 B-cell inhibitors (Rituxan): One treatment (two infusions given two weeks apart every four to six months) may provide relief of RA symptoms.

 Interleukin-1 (IL-1) inhibitors (Kineret): A daily injection.

 Selective co-stimulation modulators (Orencia): A once a month injection thought to have the lowest risk of infection.

 Interleukin-6 (IL-6) inhibitors (Actemra, Kevzara): Injection given every one to two weeks. There is also an infusion version of Actemra.

 Janus kinase (JAK) inhibitors (Rinvoq, Xeljanz): Pills taken 1 to 2 times daily.

Suppressing the immune system increases your risk of developing infections. Since each biologic partially disables an “arm” of the immune system, you will become more susceptible to certain infections when taking these drugs. For example, the TNF inhibitor biologics can increase your risk of tuberculosis and fungal infections. B-cell inhibitors can cause chest pain, difficulty breathing and flu-like symptoms, and increase your susceptibility to colds and sinus infections. Interleukin inhibitors can cause bowel perforation in rare instances. And selective co-stimulation modulators can contribute to pneumonia, tuberculosis and flu. Ask your doctor about these risks before taking biologics.