Infusions for Arthritis: What to Know

Rheumatoid arthritis (RA) treatments can vary depending on the range and severity of your symptoms.

When people with RA don't respond well to other treatments, they may receive infusions for arthritis to help decrease their bodies' autoimmune response and improve symptoms of joint pain, inflammation, and stiffness.

Rheumatoid Arthritis Basics 

RA is an autoimmune condition in which the body produces an immune system response to attack the joints, causing pain, inflammation, and swelling. Over time, the cartilage breaks down, narrowing the space between bones, and joints can become unstable or stiff. If left untreated, RA can cause permanent and irreversible joint damage.

Women are 2 to 3 times more likely to be diagnosed with RA than men.

Commonly prescribed medications for RA include nonsteroidal anti‐inflammatory drugs (NSAIDs, such as ibuprofens like Advil or naproxen like Aleve) and disease-modifying antirheumatic drugs (DMARDs) like Otrexup (methotrexate). These medications can help reduce pain and inflammation. If these medications fail to improve symptoms, biologic medications are usually recommended next.

Biologics are a class of drugs that suppress targeted areas of your immune system to reduce inflammation in autoimmune diseases. Biologic medications used to treat RA come in injection or infusion forms. The medications target certain cells or inflammatory proteins involved in autoimmune responses.

Types of Infusions for Arthritis 

There are currently several different medications used for infusions for arthritis that fall under various classes of biologics based on mechanism. These include the following.

Tumor Necrosis Factor (TNF) Inhibitors

Tumor necrosis factor (TNF) is a specific cytokine, or inflammatory protein, that increases with inflammatory autoimmune conditions. TNF inhibitors decrease inflammation throughout the body by blocking the activity of TNF.

Remicade (infliximab) is a TNF inhibitor approved for infusion treatment for RA.

Interleukin Inhibitors

Interleukins are inflammatory cell-signaling proteins that are elevated with inflammatory autoimmune conditions. Interleukin inhibitors decrease inflammation throughout the body by blocking the activity of interleukins.

Actemera (Tocilizumab) is an interleukin inhibitor approved for infusion treatment for RA that specifically blocks interleukin-6.

B Cell Inhibitors

B cells are overactive in autoimmune conditions like RA, and B cell inhibitors work by attaching to and blocking the activity of B cells. More specifically, B cell inhibitors block the activity of lymphocytes, or white blood cells, that produce antibodies to start an immune system response.

Rituxan (rituximab) is a B-cell inhibitor approved for infusion treatment for RA.

T Cell Inhibitors

T cell inhibitors block the activity of T cells, specific lymphocytes, or white blood cells, involved in immune system responses. T cells help destroy viruses and activate cytokine pathways to recruit other cell types, such as B cells, to produce an immune system response. T cells are overactive in autoimmune conditions like RA, and T cell inhibitors work by attaching to and blocking the activity of T cells.

Orencia (abatacept) is a T cell inhibitor approved for infusion treatment for RA.

What to Expect 

Infusions for arthritis are performed by a healthcare provider in a hospital or infusion center. You'll need to schedule an appointment ahead of time.

Before beginning treatment, your vital signs such as your heart rate and blood pressure will be checked and then monitored for the duration of your infusion treatment. You may be given medication before your infusion treatment to reduce the likelihood of an allergic reaction or to help you relax during treatment.

Infusions for arthritis are delivered intravenously through an IV into a vein in your arm. You'll feel a sharp pinch when the needle is inserted. Other than the initial needle stick, you shouldn't experience pain. During your treatment, you can read a book, watch television, or use your phone to keep you occupied.

Your infusion dosing schedule will also vary depending on the medication as follows:

• Orencia (abatacept): Every two weeks for the first month, then once a month
• Actemera (tocilizumab): Once every four weeks
• Remicade (infliximab): Three infusions within the first six weeks of treatment, followed by one infusion every eight weeks
• Rituxan (rituximab): Two infusions spaced two weeks apart, every year

Risks and Side Effects 

During your infusion treatment, you'll be monitored by a healthcare professional for any adverse reactions to treatment. The most common side effect of infusion treatment is mild pain, redness, or swelling at the injection site. Other possible side effects include headaches, nausea, or fatigue after infusion treatment.

There is always a possibility of having an allergic reaction when taking medication. Contact your healthcare provider immediately if you experience:

• Shortness of breath
• Fever
• Chills
• Numbness
• Tingling
• Rash, redness, or itchiness
• Pain at the injection site

While a 2017 systematic review suggests that adverse side effects of taking biologic infusions for RA aren't statistically different from taking a placebo, a substance of no therapeutic value given to some people in a study to observe the response in others taking an actual medication. A slightly increased risk of adverse side effects, such as infusion site reaction, may be associated with Orencia (abatacept) and Rituxan (rituximab).

Because biologic medication weakens your immune system, it can also increase your risk of getting an infection or reactivating a prior infection such as hepatitis B or tuberculosis.

Getting Started

Before taking any biologic medication, you should always have your healthcare provider do a thorough medical examination and discuss your symptoms and medical history. They'll then decide if the benefits of taking a biologic medication for RA outweigh the potential risks. Biologic medication is usually well-tolerated with few adverse side effects.

Because biologics are often expensive and more invasive than other types of medications, they're often prescribed after you have already tried other medications such as oral steroids.

Other Considerations

Because biologic medication suppresses your immune system, live vaccines that contain live viral components are typically avoided. You may need to get certain vaccines, such as tuberculosis or hepatitis B, before starting biologic medications.

The efficacy of infusion treatment for RA varies between medication types. There's also a risk of your body developing antidrug antibodies in reaction to the infusion, in which your body attacks and destroys the medication being delivered. In these cases, the infusions won't be as effective in reducing inflammation from RA to treat symptoms. 

While everyone responds to infusion treatment differently, a 2017 systematic review suggests that the Remicade (infliximab) has a higher overall rate of formation of antidrug antibodies compared to other biologic medications.

Summary

When people with RA don't respond well to other treatments, they may receive infusions for arthritis to help decrease the autoimmune response and improve symptoms.

Biologic medication used to treat RA comes in injection or infusion form. The medications target certain cells or inflammatory proteins involved in autoimmune responses. There are currently four different medications used for infusions for arthritis that fall under four different classes of biologic medications. You can expect to start seeing improvement in your symptoms after three months of infusion treatment.

Before taking any biologic medication, you should always have your healthcare provider do a thorough medical examination and discuss your symptoms and medical history. They'll then decide if the benefits of taking a biologic medication for RA outweigh the potential risks.

A Word From Verywell 

Biologic infusions for RA are considered the most targeted therapy for reducing symptoms of this autoimmune condition. Infusions can suppress chronic inflammation, resulting in a decrease in symptoms of RA and joint destruction. 

While they may not be effective for everyone, infusions for arthritis can help manage symptoms of RA when other first-line treatments like DMARDs and steroids fail to improve symptoms. Be sure to discuss the benefits and risks of biologic infusions with your healthcare provider to determine if they are an option worth trying to help manage your RA.