Biologic Treatment for Arthritis in India: What to Know Before You Start
Short answer: Biologics are targeted medicines made from living cells that block specific parts of the immune system. They are used for rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and some other conditions when standard medicines are not enough. Before starting, you need screening for TB, hepatitis B, hepatitis C and HIV, and your rheumatologist will check your vaccines and overall health.
What are biologics?
Biologics work on specific signals in the immune system, such as TNF, interleukin-6, interleukin-17 or B cells, instead of calming the immune system broadly. They are given as injections under the skin or as infusions through a drip. They are not steroids, and they are not painkillers.
Who may need a biologic?
- Rheumatoid arthritis that is still active after standard disease-modifying medicines such as methotrexate. See rheumatoid arthritis.
- Ankylosing spondylitis that has not responded to anti-inflammatory medicines and exercise. See ankylosing spondylitis.
- Psoriatic arthritis and some other inflammatory conditions, as decided by your rheumatologist.
Tests needed before starting
Biologics lower the body’s defences against certain infections, so these checks are essential:
| Check | Why |
|---|---|
| TB test (IGRA) and chest X-ray | Biologics can wake up hidden (latent) tuberculosis |
| Hepatitis B, hepatitis C and HIV | Treatment can reactivate hepatitis B; HIV and hepatitis C change how treatment is planned |
| CBC, liver and kidney tests | A baseline for later monitoring |
| Vaccination review | Flu, pneumonia and other vaccines ideally before starting; live vaccines are avoided |
Screening is confidential and done with your consent. A positive result does not always rule out a biologic, and your doctor can arrange protective treatment so you can still benefit.
What to expect during treatment
- Regular follow-up to check how the arthritis is responding and to review blood tests.
- Injections or infusions at set intervals, from weekly or fortnightly injections to infusions every few weeks or months, depending on the medicine.
- A lower guard against infection. Tell your doctor early if you have fever, a persistent cough, or a wound that is not healing. Do not wait it out.
Safety: call your doctor if
- You develop a fever, chills or persistent cough
- You are exposed to someone with tuberculosis
- You plan a surgery or dental procedure, or are planning pregnancy
- You have a skin infection or an unexplained rash
Cost and biosimilars
Biologics can be expensive. In India, biosimilars (highly similar versions of the original biologic) are available and are generally less costly. Your rheumatologist can explain the options for your condition. At OARC Saheed Nagar, biologic infusion is available under one roof. See OARC Saheed Nagar.
Common myths
- “Biologics are steroids.” No. They are a separate class of medicines.
- “Once I start, I can never stop.” Some people can reduce or pause treatment under supervision once the disease is controlled.
- “They cure arthritis.” They control it, and many people live with little or no disease activity, but stopping treatment can cause a flare.
Frequently asked questions
Is biologic treatment safe?
For most people, with proper screening and follow-up, yes. The main risk is infection, which is why TB, hepatitis and HIV screening and regular monitoring matter.
Do I need to stop methotrexate when I start a biologic?
Often not. Biologics are frequently combined with methotrexate, but your rheumatologist decides based on your condition.
Can I have biologics if I have latent TB?
Usually yes, after starting preventive TB treatment, as advised by your doctor.
How soon do biologics work?
Many people notice improvement in a few weeks, with the full effect over three to six months.
Book an appointment
You can book online at OARC Saheed Nagar or OARC Sailashree Vihar in Bhubaneswar, or call or WhatsApp +91 93386 53086. OARC Saheed Nagar is open Monday to Saturday, 9:00 AM–2:00 PM and 4:30–9:00 PM. OARC Sailashree Vihar is open Monday to Saturday, 8:00–9:00 AM and 5:00–6:00 PM. Both are closed on Sunday. Tests ordered at your visit can be done at our in-house laboratory, Immunix Labs, with sample collection at both centres and at home.
Sources
- Fraenkel L, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res 2021;73:924–939.
- NICE guideline NG65: Spondyloarthritis
- NHS: Rheumatoid arthritis, treatment
Medical review: Dr. Jyoti Ranjan Parida, DM (Rheumatology), review pending. This article is general information and not a diagnosis. See our editorial policy.
