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If your arthritis is not well controlled on conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs), your treatment may be escalated to either a biologic disease modifying anti-rheumatic drug (bDMARD or biologic) or targeted synthetic disease modifying anti-rheumatic drug (tsDMARD) by your rheumatology clinician.
One of the Rheumatology Specialist Nurses or the Specialist Pharmacists will already have discussed with you which medicine you will be taking.
This page has been created to help you remember the important key information in relation to your medicine.
bDMARDs are a group of medications that are used to treat arthritis (such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis).
These medicines can decrease the amount of inflammation you have and reduce the damaging effects of your arthritis on your joints.
There are now quite a few bDMARDs available to treat different types of arthritis; which medicine you have been prescribed may depend on the type of arthritis that you have or another medical condition at the same time as your arthritis that might make one treatment more appropriate than another.
At the time of writing, bDMARDs used for different conditions include:
However more are becoming available very often.
bDMARDs can be given either as an injection into the layer of fat just underneath the surface of your skin (a subcutaneous injection) or by a drip into your vein (intravenous infusion).
If you have a subcutaneous injectable medication you can be taught how to do this yourself at home or someone can be taught to give you the injections, such as a family member.
If you are having an intravenous infusion you will need to come to the Medical Day Care Unit in Southmead Hospital which is located on Level 1 in Gate 5 of the Brunel building.
Some of the bDMARD medicines listed above are now available in the UK as similar versions made by different companies, because the patent (allowing one company to make the product exclusively) has expired.
These different versions of existing bDMARDs are known as ‘biosimilars’ because they are deemed to be sufficiently similar (in terms of safety and effectiveness) to the original product.
Switching between biosimilar brands should not affect the safety or the effectiveness of your medicine.
Switching patients to the most cost-effective version of bDMARD allows the NHS to treat more patients with these expensive therapies.
NHS England may ask us to change the brand of bDMARD medication you are prescribed from time to time and we will discuss this with you.
tsDMARDs are targeted synthetic therapies.
Like biologic medicines, they target specific parts of the immune system, however they are not made from living cells. They are smaller chemical drugs and can usually be taken by mouth.
There are now quite a few tsDMARD medicines available to treat different types of arthritis; which medicine you have been prescribed may depend on the type of arthritis that you have or your other relevant medical conditions.
At the time of writing, this group of medicines include:
But others are going through approval steps so may be available soon.
When your consultant or clinician decides it would be appropriate to start a b/tsDMARD therapy, we will usually invite you to a clinic appointment with the Rheumatology Specialist nurse or Rheumatology Specialist Pharmacist to carry out your baseline assessments (this usually includes a joint examination and blood tests) and talk to you about your new treatment options.
The Nurse or Pharmacist will complete some paperwork with you and discuss the main symptoms associated with your condition, your other medical problems, previously tried therapies and any patient preferences you might have.
Once we have discussed your condition and preferences, we will look at the most cost-effective treatment to suit your needs.
We will support you to make a shared, informed decision about the most appropriate treatment for you.
This depends on whether you take another medication, such as methotrexate, with the b/tsDMARD medicine.
If you are taking another medication with the b/tsDMARD medicine
You should be having regular blood tests via your GP to monitor this, and you will not need any different or additional blood tests (unless we tell you). You need to phone your GP surgery to arrange these blood tests.
Once you have started treatment, we will usually give you a call after a couple of months to see how you are getting on with your new medication. We will then invite you to attend a face-to-face appointment to check your joints and see if you are responding to your new treatment. This appointment will be either 3, 4, 5 or 6 months after starting treatment, depending on which treatment you are on.
You will then be followed up routinely every 6 months.
Your review appointments may be face to face or in our Remote Therapy Clinic (RTC). This can be via telephone, video, or occasionally we may be able to complete a virtual review which means we have checked your hospital records and blood tests and have deemed it safe to prescribe further medication without speaking to you, but we will always write to you to let you know if this is the case.
If you feel you need to be seen sooner than your scheduled appointment or if you feel you need to be seen face-to-face rather than remotely, please contact us via the rheumatology advice line; you do not have to wait until your scheduled appointment.
It is very important that you do attend regularly for reviews with your Rheumatology Team as the prescriptions of the b/tsDMARD medicines are based on your hospital appointments – if we do not review you in clinic (face-to-face or remotely), we will not be able to prescribe more b/tsDMARD medicine until we have seen you.
It is really helpful for us to understand how you are responding to your b/tsDMARD medication.
Some patients are able to track their symptoms, disease activity and overall wellbeing on a disease activity tracking smartphone application. If you are not already using this but are keen to do so, please contact our rheumatology team so we can register you for this service (free of charge).
If you are expecting to be seen by the hospital but do not receive an appointment letter, please get in touch with us to check you have been booked into an appointment.
It usually takes about 3-6 months for your b/tsDMARD to be fully effective, although some patients feel the benefit much sooner. We might prescribe you some other medication to help with symptoms whilst waiting for your b/tsDMARD to have an effect.
If your new medication doesn’t help improve your symptoms, we may need to stop your medication, allow for it to come out of your system and decide on an alternative treatment.
Sometimes, your medication will work very well at the beginning but might lose effect over time. If this happens, we may need to stop your medication, allow time for it to come out of your system and chose an alternative treatment.
It is important that you attend your follow up appointments so we can check how well your medication is working. Please always be honest with how your symptoms are feeling.
You should not have your b/tsDMARD medicine if you are unwell in any way, if you are currently taking antibiotics or if you have just had or are having any surgery in the next few weeks.
You can use the checklist below to help you to decide if it is safe for you to give the injection or to help you decide if you should contact us for further advice before your infusion.
If you say ‘yes’ to any of the above you should contact us on the rheumatology advice line for further advice before giving your injection or before attending your next appointment for an infusion.
It is usually safe to restart your b/tsDMARD medication when you are feeling well and you do not have any signs of symptoms of an infection.
We recommend not starting treatment until at least 48hrs after completing the course of antibiotics as long as you are well.
If you restart your b/tsDMARD therapy on a different day to your usual injection day, this will become your new injection day and you need to count the dosing interval from this day. Never shorten the gap between doses.
If you develop chicken pox, shingles or come into contact with someone who has chicken pox or shingles (and you have not had it before), stop your b/tsDMARD and seek medical attention.
Although we have more information to suggest some bDMARD therapies are safe to use in specific trimesters of pregnancy, it is generally advisable that you do not become pregnant whilst on a b/tsDMARD medicine unless you have discussed this with your rheumatology consultant first and been told it is safe to continue taking your medicine.
Although it is thought that a number of therapies can be considered safe in men who wish to father children, it is advisable that you discuss this with your rheumatology consultant first and check it is safe to continue taking your medicine.
This decision is made on your personal needs and your thoughts and beliefs are taken into consideration before making the decision; this is to make sure that any decision made is the best one for you and your family.
You should make sure that you use reliable contraception whilst taking a b/tsDMARD medicine.
You will need to come off your treatment for a certain amount of time beforehand to lower your infection risk with your surgery. Please contact us on the rheumatology advice line well in advance if your surgery so we can advise on the appropriate time to stop your b/tsDMARD.
It is important you let the surgical team know when you last had your dose of b/tsDMARD in case you need some preventative antibiotics.
You should also carry your b/tsDMARD alert card around with you.
You can usually restart your b/tsDMARD when your wound shows evidence of healing, any sutures/staples are out, there is no significant swelling, redness or drainage and there is no ongoing nonsurgical site infection, which is typically around 14 days.
The information leaflet provided with your medication will list the potential side effects with your specific b/tsDMARD and some information on the likeliness of them occurring.
How long will I be on my b/tsDMARD medication?
The rest of this page focuses on the important parts to remember if you are taking an injectable form of bDMARD or oral tsDMARD medicine that is supplied via a home delivery provider.
Your b/tsDMARD medicine can only be prescribed by your Rheumatology team through the hospital. This means that you won’t be able to collect it with your usual medicines from your pharmacy, chemist or GP.
We use a Home Delivery Service who will deliver your medication to you at home. If you wish, you may arrange with them to deliver your medication to an alternative address (e.g. work address) if this would be more suitable (but this cannot be a local GP or community pharmacy).
Your Rheumatology Specialist Nurse or Specialist Pharmacist can give you details about which home delivery service will be delivering your medication.
If this happens then you will need to contact the homecare delivery company who deliver your medicine and let them know so that they can arrange for the affected medication to be replaced.
You will also need to let the Rheumatology department know by calling the rheumatology advice line in case we need to provide the homecare delivery company with another prescription.
In some circumstances, we may advise that one or two injections can still be used, but we will provide personal instructions to you depending on your situation.
tsDMARD medicines do not need to be stored in the fridge.
If you forget to give an injection then you should give a dose as soon as you remember and then make sure that you take the next dose at the correct interval to make sure that you do not give the next dose too early.
For further advice on the specific medicine you are taking please contact the Rheumatology Advice Line.
If you forget to take a tablet (tsDMARD), do not take a double dose to make up for the forgotten dose. Take your next tablet at the usual time and continue as before.
If the pen or syringe slips when you are giving your injection or if the device does not work properly for any reason please contact us on the Rheumatology Advice Line for more help on the particular problem you have experienced.
Do not try and inject another dose in case some of the first dose was given.
If you think that your pen or syringe is faulty for any reason please make a note of the batch number and expiry date (this information can be found on the box containing your medicine).
Please report any faulty pens or syringes to your home care delivery company.
You will be supplied with a sharps bin for disposing of your injections. When your sharps bin is full with used pens/syringes, contact your homecare company to arrange a collection for disposal.
It is possible to travel (either abroad or within the UK) with your b/tsDMARD medicine, but you will need to plan ahead.
If you:
If you:
To arrange your blood tests and let them know once you’ve had your first dose of b/tsDMARD.
If you have an allergic reaction to your medication or severe side effect.
An injection using either a syringe or a pen injection device. The injection is given into the small layer of fat just underneath the surface of the skin.
Medication which is given slowly through a needle in your vein.
These are different versions of existing biological medicines, thought to have similar effectiveness and safety, brought out because the patent (allowing one company to make the product exclusively) has expired.
This is a term which is commonly used when patients have just one medicine to control their arthritis.
Removal of a tooth, which would leave a hole in the gum and may become infected.
Filling material is placed in the canals and the tooth is sealed with a temporary filling to protect it from infection. Then a crown is usually placed over the tooth to seal and protect it from recontamination and future damage.
www.versusarthritis.org/about-arthritis/
Telephone: 0117 414 0600
111 (Monday to Friday, 6.30pm - 8am, all day weekends and Bank Holidays)
rheumatologyadviceline@nbt.nhs.uk
Contact the rheumatology advice line to sign up.