How I Learned About Biologic Therapies

Learning the science of rheumatology is, for me, an ongoing project. The immune cascade is amazing and yet daunting to comprehend. The exciting part is that science has not only found DNA markers to help make a diagnosis, but each year, more medications to put RA into remission. When I joined my current rheumatology practice, there were 3 drugs in the biologic family and now there are 13.

Learning is constantly ongoing in rheumatology, and it is our duty to stay on top of trends and new findings…

At my first rheumatology conference, I spent much of my time reading about the various biologic therapies on my pocket reference (sadly, this was before the days of the iPhone). I learned what the suffix “mab” meant. I learned that the term monoclonal antibody signified a laboratory-produced substance that locates and binds to a specific cytokine such as tumor necrosis factor. I learned that the term “chimeric” referred to the mouse protein present in infliximab and etanercept. Not long after I returned, a patient who was taking infliximab earnestly asked me if the drug would make her want to eat more cheese!

Initially I strived to remember which drug had the “emab” (hamster) vs. the “zumab” (humanized) protein, but I quickly realized that drug classification, function, and side effects were much more important than the genesis of the protein used to manufacture each drug.

Breaking down the medications and explaining their actions and side effects to our patients can be a daunting task. I always find that I struggle getting my patients to understand that RA is a disease that affects not just the bones, but every organ and vessel in the body. Patients are often so focused on potentially serious but unlikely side effects of treatment such as lymphoma, progressive multifocal leukoencephalopathy, or chronic lymphocytic leukemia that they don’t focus enough on the importance of mitigating inflammation to improve their quality of life and reduce the possibility of crippling pain and deformity.

With the advertising on television, once the diagnosis of RA is made, I often get patients who request “the drug that (golfer) Phil Mickelson uses” or “you know, the lady on the horse with daisies!” It’s important for us to explain to those patients that we’ll start with less invasive therapies such as methotrexate and steroids that might well control their disease before potentially ramping up to those drugs they have heard about on TV.

An unrelated but short piece of advice—warn your patients frequently that no biologic can be combined with another biologic and that they MUST have labs as ordered, be cautious with any potential infection, and hold any rheumatologic drug during illness for 2 weeks before and after surgery. I have learned you can never remind your patients about this too much.

Learning is constantly ongoing in rheumatology, and it is our duty to stay on top of trends and new findings to better serve our patients. Resources such as those provided by RNS are one way to stay abreast of the field and become a lifelong learner.

AUTHOR PROFILE: Jacqueline Fritz, RN, MSN, CNS, is owner and Coordinator of Education at the Medical Advancement Center in Cypress, CA, where she teaches RN/BSN programs at various facilities. She is also a Critical Care Clinical Nurse Consultant to many acute care facilities in the California area, such as Cigna, Arcadia Methodist, and Doctor’s Hospital of Lakewood.