Biologics for Rheumatoid and Psoriatic Arthritis, Explained in Plain English

What are biologics for rheumatoid arthritis and psoriatic arthritis?

Biologics are medicines made from living cells that target specific parts of the immune system — such as the protein TNF or the messenger interleukin-17 — that drive joint inflammation. For rheumatoid and psoriatic arthritis, they reduce pain, swelling, and stiffness and can slow or help prevent joint damage. They are given by injection or intravenous infusion.

The U.S. Food and Drug Administration (FDA) defines biologics as products made from living sources, which makes them larger and more complex than traditional pills. In rheumatology, most biologics are antibodies or engineered proteins designed to lock onto one inflammatory target. Because they are so specific, they can work well for people whose disease remains active despite conventional disease-modifying antirheumatic drugs (DMARDs) such as methotrexate.

Biologics are part of a larger treatment toolbox. They are often combined with methotrexate, especially in rheumatoid arthritis, because the combination can work better and may help prevent the body from forming antibodies against the biologic. In psoriatic arthritis, the choice of biologic also considers skin psoriasis, nail disease, the spine, the eyes, and the gut.

How do biologics work in plain English?

In autoimmune arthritis, the immune system sends chemical messages that keep inflammation switched on inside the joints. Biologics intercept one of those messages or the cells that send them. With the signal blocked, swelling and pain settle, and the process that erodes cartilage and bone slows down.

Think of inflammation as a loud group conversation in which a few voices keep everyone agitated. Older medicines lower the volume of the whole room. A biologic picks out one loud voice — TNF, IL-6, IL-17, or IL-23 — and mutes it. Different people have different “loudest voices,” which is one reason a person may respond well to one class and not another.

Biologics generally work faster than conventional DMARDs; some people notice improvement within a few weeks, though full benefit can take about three months. If one does not work or stops working, switching to a different mechanism is common and often successful.

What are TNF inhibitors and why are they often used first?

TNF inhibitors block tumor necrosis factor, a key inflammatory protein in rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis. They have been used for over two decades, have extensive long-term safety data, and come in several forms, including self-injected pens and infusions. Many people start a TNF inhibitor as their first biologic.

Adalimumab, etanercept, certolizumab pegol, and golimumab are self-injected under the skin on schedules that range from weekly to monthly. Infliximab and an intravenous form of golimumab are given by infusion. Because they have been studied for so long and several now have biosimilar versions, TNF inhibitors are often the first biologic considered — though not always. Prior infections, heart failure, a history of multiple sclerosis or similar conditions, and personal preference all factor into the choice.

What other biologic classes are used for RA and psoriatic arthritis?

Beyond TNF inhibitors, rheumatoid arthritis may be treated with IL-6 inhibitors, abatacept, or rituximab, while psoriatic arthritis may be treated with IL-17 or IL-23 inhibitors or abatacept. Each class blocks a different step in inflammation, so a person who does not respond to one often benefits from switching to another mechanism.

• IL-6 inhibitors (tocilizumab, sarilumab): used in rheumatoid arthritis, including for people who cannot take methotrexate. The ACR notes that blood counts, liver tests, and cholesterol are monitored.
• Abatacept: blocks a signal T cells need to become fully activated. According to the ACR, it is available as a weekly self-injection or a monthly infusion.
• Rituximab: depletes certain B cells and is given as infusions, usually spaced months apart, for rheumatoid arthritis.
• IL-17 inhibitors (secukinumab, ixekizumab, bimekizumab): particularly helpful when psoriasis of the skin is significant, as well as for spine involvement.
• IL-23 and IL-12/23 inhibitors (guselkumab, risankizumab, ustekinumab): used for psoriatic arthritis and psoriasis, often with infrequent dosing once started.

Psoriatic disease affects the whole person, so the best choice weighs skin, nails, joints, and other features. Our article on psoriatic arthritis signs in the skin and joints explains why these details matter.

Are JAK inhibitors biologics?

No. JAK inhibitors such as tofacitinib, upadacitinib, and baricitinib are targeted synthetic DMARDs — small-molecule pills rather than biologics. They block Janus kinase enzymes inside cells that relay several inflammatory signals at once. They can be very effective, but the FDA requires boxed warnings about serious heart events, cancer, blood clots, and death.

In 2021, after a large safety study of tofacitinib, the FDA required warnings for JAK inhibitors used in arthritis and limited their approved use to people who have not responded well to, or cannot tolerate, one or more TNF inhibitors. Risk appears higher in people who are 50 or older, current or past smokers, or who have other cardiovascular risk factors. For the right patient, JAK inhibitors remain a valuable option, and your rheumatologist will weigh these risks with you.

What tests are needed before starting a biologic?

Before starting a biologic or JAK inhibitor, doctors screen for tuberculosis (TB) with a skin test or blood test, check for hepatitis B and hepatitis C, and review blood counts, liver and kidney function, and vaccination history. These steps help catch hidden infections that these medicines could reactivate.

Latent TB is a silent infection that causes no symptoms but can reactivate when certain immune pathways are blocked — especially with TNF inhibitors. If screening shows latent TB, it can be treated, and a biologic is often started after treatment has begun. Hepatitis B can also reactivate, so a positive test may require antiviral medicine or close monitoring. Depending on the drug, your doctor may also check cholesterol or other labs.

Which vaccines should you get before and during biologic treatment?

Inactivated vaccines — such as the flu shot, COVID-19 vaccines, pneumococcal vaccines, and the non-live recombinant shingles vaccine — are generally recommended for people on biologics. Live vaccines are usually avoided during treatment. Ideally, vaccines are reviewed and updated before your first biologic dose.

Some immune-modulating medicines, such as rituximab, can blunt the response to vaccines, so timing matters. Ask your rheumatologist which vaccines you need and when to get them, and tell any pharmacist or doctor giving a vaccine that you take a biologic. MedlinePlus has a helpful overview of vaccine types if you want to understand the difference between live and inactivated vaccines.

Do biologics increase the risk of infection?

Yes. Because biologics calm part of the immune system, they modestly increase the risk of infections, including serious ones such as pneumonia and skin infections, and can reactivate TB or hepatitis B. Most people take them safely. Report fever, persistent cough, or signs of infection promptly, and ask before surgery whether to pause a dose.

The balance usually favors treatment: uncontrolled inflammatory arthritis carries its own risks, including joint destruction, disability, and higher cardiovascular risk. Practical habits help — staying current on vaccines, handwashing, food safety, and calling your doctor early rather than waiting out a fever.

What is the difference between biologic injections and infusions?

Many biologics are self-injected under the skin at home with a prefilled pen or syringe, on schedules ranging from weekly to every few months. Others are given as intravenous infusions in a monitored clinical setting, typically every few weeks to every six months. The choice depends on the drug, your preferences, and insurance coverage.

Self-injection offers flexibility and avoids travel, and most people learn the technique quickly with nurse or pharmacist teaching. Infusions involve sitting for a period while the medicine drips in through an IV, with staff monitoring for reactions, and some people like the structure and fewer doses. Some medicines, like abatacept, come in both forms. Store injectable biologics as directed — usually refrigerated — and keep them out of hot cars during Texas summers.

What are biosimilars, and are they as good as the original biologic?

Biosimilars are FDA-approved biologics that are highly similar to an existing reference biologic, with no clinically meaningful differences in safety, purity, or effectiveness. They often cost less. Several biosimilars of adalimumab, infliximab, etanercept, and tocilizumab are now approved, giving patients and insurers more options.

Because biologics are made in living cells, no two batches are perfectly identical — even of the original brand. The FDA requires biosimilar makers to show their product works the same way, at the same dose, with the same expected results. Some biosimilars also earn an “interchangeable” designation, which may allow a pharmacist to substitute them for the reference product, subject to state pharmacy laws. The ACR provides patient-friendly information on biosimilars if you have been switched by your insurer and have questions.

Why do biologics need insurance prior authorization?

Biologics are expensive specialty medicines, so most insurance plans require prior authorization — documentation from your doctor showing the medicine is medically necessary. Plans may also require step therapy, meaning you try preferred drugs first. Approval can take days to weeks, and manufacturer or foundation assistance programs can sometimes reduce out-of-pocket costs.

Your rheumatologist’s office typically submits your diagnosis, disease activity, prior treatments, and screening results. If coverage is denied, an appeal with additional information is often possible. Keep a list of every arthritis medicine you have tried, with dates and why it was stopped — this history speeds up approvals. Our insurance page explains how to get started with the practice.

Where can I get biologic treatment guidance in West Houston, Katy, or Fulshear?

West Houston Arthritis and Rheumatology helps adults with rheumatoid arthritis, psoriatic arthritis, and related conditions decide whether a biologic or targeted therapy fits their situation, and manages screening and ongoing monitoring. The practice is led by Dr. Syed Alam, MD, FACR, a double board-certified rheumatologist accepting new patients.

Dr. Alam is board-certified in internal medicine and rheumatology, completed his rheumatology fellowship at Temple University Hospital and his internal medicine residency at John H. Stroger, Jr. Hospital, and has more than 10 years of rheumatology experience. The office is at 19002 Park Row Blvd, Suite 100, Houston, TX 77084, open Monday through Friday, 8:00 AM to 5:00 PM. Call (832) 305-5226.

Patients come from Katy, Fulshear, Cinco Ranch, Cypress, Richmond, Rosenberg, Sealy, Sugar Land, and West Houston, and patients from elsewhere in Texas may request an appointment. Learn more about rheumatoid arthritis treatment, psoriatic arthritis treatment, our guide to methotrexate and lab monitoring, or a rheumatology second opinion.

Key takeaways

• Biologics for rheumatoid arthritis and psoriatic arthritis block specific inflammatory targets such as TNF, IL-6, IL-17, or IL-23.
• JAK inhibitors are targeted synthetic pills, not biologics, and carry FDA boxed warnings that your doctor will weigh with you.
• TB and hepatitis screening and a vaccine review come before the first dose.
• Biologics modestly raise infection risk, so report fever or persistent cough promptly.
• Biosimilars are FDA-approved alternatives with no clinically meaningful differences, and most biologics require insurance prior authorization.

Frequently asked questions

How long does it take for a biologic to work?

Some people notice improvement within two to four weeks, but full benefit often takes about three months. Your rheumatologist will typically reassess after a few months to decide whether to continue or switch.

Do I have to stop methotrexate when I start a biologic?

Not necessarily. In rheumatoid arthritis, biologics are often combined with methotrexate because the combination can work better. Your doctor will decide based on your response and tolerance. Do not stop any medicine on your own.

Can I take a biologic if I had TB exposure in the past?

Often yes. If screening shows latent TB, it can be treated, and a biologic may be started once treatment is underway. Your doctor will coordinate the timing.

Are biologics a type of chemotherapy?

No. Biologics for arthritis are targeted immune-modulating medicines, not chemotherapy. They calm specific inflammatory signals rather than killing rapidly dividing cells.

Can biologics be stopped if my arthritis goes into remission?

Some people in sustained remission can carefully lower the dose or space out doses under close supervision. Stopping abruptly often leads to flares, so any change should be planned with your rheumatologist.

Is it safe to travel with injectable biologics?

Yes, with planning. Keep pens in their original packaging, use an insulated cooler if refrigeration is required, carry a copy of your prescription, and avoid leaving them in a hot car.

Your next step

Sources and further reading

1. What Are “Biologics” Questions and Answers, U.S. Food and Drug Administration.
2. Biosimilar Basics for Patients, U.S. Food and Drug Administration.
3. FDA Requires Warnings About Increased Risk of Serious Heart-Related Events, Cancer, Blood Clots, and Death for JAK Inhibitors, U.S. Food and Drug Administration.
4. Biosimilars, American College of Rheumatology.
5. Abatacept (Orencia), American College of Rheumatology.
6. Tocilizumab (Actemra), American College of Rheumatology.
7. Biologic Drugs for Arthritis, Arthritis Foundation.
8. Psoriatic Arthritis, National Institute of Arthritis and Musculoskeletal and Skin Diseases.