A patient who says their biologic has stopped working may be right, but the reason is often something other than uncontrolled inflammation. Before switching, work through a short list.
Is there objective inflammation — swollen joints, dactylitis, enthesitis on examination or ultrasound, raised CRP? Is the patient taking the drug as prescribed and at the right interval? Is pain better explained by fibromyalgia, osteoarthritis or mechanical problems? Is there untreated depression or sleep disturbance? And has an infection or intercurrent illness caused a temporary flare?
- Examine for swollen joints, dactylitis and enthesitis, and check CRP
- Confirm adherence and dosing interval
- Consider fibromyalgia, osteoarthritis and mechanical pain
- Screen for depression and poor sleep
- Exclude intercurrent infection before calling it failure
Why it matters
It prevents cycling through drugs that were never the problem.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for rheumatology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free