In short
Immunomodulation is the core of rheumatology treatment: medicines that reduce the immune activity driving the disease, chosen and combined for the individual. They range from conventional disease-modifying drugs such as methotrexate, through targeted synthetic agents, to biologics that block a single molecule in the inflammatory pathway.
Treating to a target
Modern practice does not aim to make symptoms tolerable. It sets a defined target — remission, or low disease activity where remission is not achievable — measures progress against it at set intervals, and changes treatment when the target is not met. This approach is what changed the long-term outlook in rheumatoid arthritis and spondyloarthritis over the last two decades.
The classes of treatment
Conventional DMARDs — methotrexate, leflunomide, sulfasalazine, hydroxychloroquine, azathioprine, mycophenolate — remain the foundation, and for many patients are all that is needed.
Targeted synthetic agents, the JAK inhibitors, are tablets that block intracellular signalling and work quickly, with specific cardiovascular and thrombotic considerations that guide who they suit.
Biologics are given by injection or infusion and block one precise target: TNF, interleukin-6, interleukin-17, interleukin-23, B cells or T-cell co-stimulation. Which one is right depends on the disease, on organ involvement, on other conditions, and on plans for pregnancy.
Corticosteroids control inflammation quickly and are used as a bridge while slower drugs take effect, at the lowest dose and for the shortest time that works.
Safety and monitoring
Before immunosuppression begins: screening for tuberculosis, hepatitis B and C, checks on blood counts, liver and kidney function, and a vaccination plan — inactivated vaccines can be given during treatment, live vaccines cannot.
During treatment: scheduled blood tests, more frequent at the start and after any dose change. Most serious problems are picked up on monitoring before they cause symptoms, which is the entire point of the schedule.
Pregnancy
Several of these medicines are safe in pregnancy and several are absolutely not. This is planned in advance, not managed after a positive test — and for most women with well-controlled disease, pregnancy on a compatible regimen is a reasonable and realistic goal.
Conditions this is used for
These are the conditions in which Immunomodulation & Biologic Therapy forms part of the assessment or the treatment plan. It is not a complete list, and whether it applies to you is decided at consultation.
- Rheumatoid Arthritis
- Psoriatic Arthritis
- Reactive Arthritis
- Enteropathic Arthritis
- Ankylosing Spondylitis
- Non-radiographic Axial Spondyloarthritis
- Axial Spondyloarthritis
- Systemic Lupus Erythematosus (SLE)
- Cutaneous Lupus Erythematosus
- Lupus Nephritis
- Sjögren's Syndrome
- Systemic Sclerosis / Scleroderma
- Connective Tissue Disease-Associated Interstitial Lung Disease (CTD-ILD)
- Giant Cell Arteritis
- ANCA-associated Vasculitis — GPA, MPA and EGPA
- Takayasu Arteritis
- Medium Vessel Vasculitis — Polyarteritis Nodosa (PAN)
- IgA Vasculitis
- Cryoglobulinemic Vasculitis
- Urticarial Vasculitis
- Behcet's Disease
- Dermatomyositis
- Polymyositis
- Immune-Mediated Necrotizing Myopathy (IMNM)
Whether a procedure is appropriate is decided during consultation, based on your symptoms, examination and existing reports.
Book your consultation
Consult Dr. Ashish Baweja at the Institute of Clinical Immunology and Rheumatology, Medanta – The Medicity, Gurugram.