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Rheumatology · London

RA biologics infusion, by a consultant rheumatologist.

A dedicated day unit for private rheumatoid arthritis biologics - TNFα inhibitors, rituximab, tocilizumab, abatacept and JAK inhibitors under NICE TA375, with full pre-biologic screening and DAS28 response tracking.

A stethoscope on a clinical desk

Indicative pricing

What a private RA biologic costs in the UK.

Indicative ranges across London private rheumatology units.

In short

£8,000–£24,000/year drug plus £450–£850 per infusion.

Service Indicative range
Initial rheumatology consultation and DAS28 £280–£450
Pre-biologic screening panel (TB, hep, HIV, CXR) £420–£680
Infusion administration (per session, all-in) £450–£850
Infliximab (Remicade) annual drug cost £8,000–£12,000
Rituximab (MabThera) 2 x 1g course £3,600–£5,200
Tocilizumab or abatacept annual drug cost £10,000–£16,000
JAK inhibitor (baricitinib, upadacitinib) annual £9,000–£14,000

Prices vary by unit, by drug (originator versus biosimilar), and by dosing weight for weight-based biologics such as infliximab and tocilizumab.

The problem

The right biologic, the right screening, the right unit.

A biologic started without proper TB screening, or a JAK inhibitor started without ORAL Surveillance counselling, is a preventable harm.

  • Is a biologic the right next step?

    Or would optimising methotrexate, adding leflunomide, or a course of steroid actually get you there? That is the first question to answer.

  • Which class fits your phenotype?

    TNFi for early moderate disease, rituximab for seropositive erosive RA, IL-6 for systemic features, JAK oral for convenience - matched to you.

  • Where will you be infused?

    A dedicated rheumatology day unit with resuscitation, hourly obs and infusion-nurse cover - not a shared oncology chair.

When it helps

When a biologic is the right step - and when it is not.

The clinical situations that lead patients to a biologics clinic, plus the flags that mean screening and counselling matter even more before a prescription.

  • MTX-inadequate response after 6 months

    Persistent DAS28 above 5.1, or above 3.2 with structural damage, despite methotrexate at 20 to 25mg weekly. The NICE TA375 entry point for a biologic.

  • MTX intolerance or contraindication

    Hepatotoxicity, cytopenia, severe nausea, or a planned pregnancy. Options include leflunomide combination or moving straight to a biologic monotherapy.

  • Erosive seropositive RA

    Anti-CCP or RF positive with radiographic erosions. Early biologic escalation reduces long-term joint damage - rituximab and IL-6 blockade fit well.

  • Extra-articular manifestations

    Rheumatoid nodules, vasculitis, interstitial lung disease or scleritis. Rituximab is often preferred; TNFi may worsen certain lung phenotypes.

  • Primary or secondary TNFi failure

    No response at 12 to 16 weeks (primary), or lost response after initial gain (secondary). Switch class - IL-6, CTLA-4 or JAK - rather than another TNFi.

  • Latent TB or hepatitis B carrier

    A positive IGRA needs isoniazid prophylaxis before starting a TNFi. Hep B carriers need antiviral cover and hepatology input - not a reason to withhold treatment.

  • Cardiovascular risk and ORAL Surveillance

    For patients over 65, smokers or with prior CV events, JAK inhibitors carry an increased MACE and VTE signal. A biologic is usually preferred first.

  • Red flag: active infection or malignancy

    Active sepsis, untreated tuberculosis, or recent solid or haematological malignancy needs specialist review before any biologic is started.

Drug options

RA biologics are a family - and JAK inhibitors sit beside them.

What each option actually involves, and which fits which phenotype. NICE TA375, TA466, TA744 and TA676 shape the sequencing.

  • TNFα inhibitors (Humira, Enbrel, Cimzia, Simponi)

    Subcutaneous injection weekly to monthly, self-administered at home. The default first-line biologic under NICE TA375 in MTX-inadequate RA.

  • Infliximab (Remicade) IV

    A chimeric TNFα antibody given as an IV infusion at 0, 2 and 6 weeks then every 6 to 8 weeks. Hydrocortisone premedication reduces infusion reactions.

  • Rituximab (MabThera) IV

    Anti-CD20 B-cell depletion. Two 1g IV infusions two weeks apart, repeated every 6 months. Particularly effective in seropositive RA and RA-ILD.

  • Tocilizumab (RoActemra)

    IL-6 receptor blockade, monthly IV or weekly SC. Useful when TNFi has failed, in systemic features, or when co-existent giant-cell arteritis is a factor.

  • Abatacept (Orencia)

    CTLA-4 Ig - blocks T-cell co-stimulation. Monthly IV or weekly SC. Favoured in older patients or those with a heavy infection burden.

  • JAK inhibitors (Olumiant, Xeljanz, Rinvoq, Jyseleca)

    Oral once-daily small-molecule JAK inhibitors under TA375, TA466, TA744 and TA676. Convenient but require ORAL Surveillance-informed CV and malignancy screening.

  • Biosimilar switching

    Adalimumab, infliximab, etanercept and rituximab biosimilars deliver equivalent outcomes at lower cost. Your rheumatologist can advise when a biosimilar switch is appropriate.

  • Second-opinion review

    A specialist review of your rheumatology letters, DAS28 trend and prior biologics - sometimes the right answer is optimise MTX, not add a biologic.

Safety and monitoring

What to expect - honestly.

Biologics are well-established and effective. The things worth planning are your screening panel, infection vigilance, JAK-specific counselling, and DAS28 review windows.

  • Pre-biologic screening

    TB IGRA plus chest X-ray, hepatitis B surface antigen and core antibody, hepatitis C, HIV, pregnancy test, and a full vaccination review before your first dose.

  • Vaccination boost

    Pneumococcal (PCV13 then PPV23) and annual inactivated influenza before starting. Shingrix for eligible patients. Live vaccines (yellow fever, MMR, live shingles) are contraindicated.

  • Infusion reactions

    Mild flushing or urticaria in 5 to 10% of first infusions with infliximab or rituximab. Premedication with hydrocortisone and paracetamol reduces incidence. Anaphylaxis is rare but planned for.

  • Infection risk

    A modest increase in serious bacterial infection with all biologics. Any fever above 38C, productive cough, dysuria or cellulitis needs same-day contact and treatment interruption.

  • TB reactivation with TNFi

    TNFα inhibitors carry a real reactivation risk. Latent TB (positive IGRA) needs isoniazid for at least 4 weeks before starting the biologic, continued to 6 months.

  • ORAL Surveillance and JAK inhibitors

    The ORAL Surveillance trial showed an increased signal for MACE, VTE and malignancy with tofacitinib versus TNFi in RA over 50 with a CV risk factor. Screening and counselling are standard before prescribing.

  • Pregnancy and biologics

    Certolizumab (Cimzia) has minimal placental transfer and is the preferred TNFi in pregnancy. Rituximab and JAK inhibitors are avoided. All decisions are shared with obstetrics.

  • DAS28 response at 3 and 6 months

    A EULAR good response (DAS28 fall of at least 1.2 to below 3.2) at 6 months justifies continuation. Non-response at 12 to 16 weeks triggers a class switch.

  • Red flags after infusion

    Severe rash, breathing difficulty, chest pain, high fever, unusual bruising or bleeding, or signs of infection - call the unit or go to A&E the same day.

Reading your rheumatology letter

Your biologics letter in four parts. Read the last one first.

Whichever biologic was chosen, the letter your rheumatologist sends you keeps to the same shape.

A UK rheumatologist reviewing an RA biologics letter

A quiet reminder

Rheumatology language is precise and can read coldly - ask your care team to explain anything that is unclear.

If you would like the letter talked through before your review, just ask your rheumatologist.

  1. 01 Header

    Diagnosis, seropositivity and DAS28 baseline

    RF and anti-CCP status, disease duration, erosions on imaging, and baseline DAS28 with tender and swollen joint counts and CRP.

  2. 02 Regimen

    Drug, dose and infusion schedule

    The chosen biologic, dose in mg or mg/kg, infusion interval, premedication protocol, and self-administration training if SC.

  3. 03 Findings

    Screening results and reactions

    IGRA, hepatitis panel, HIV, CXR interpretation, vaccination status, plus any infusion reactions and their management.

  4. 04 Impression

    Response plan and review interval

    Read this first: when DAS28 will be repeated, when a switch decision is made, and the safety-monitoring blood schedule.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for RA biologics varies by insurer - usually funded where NICE TA375 criteria are met.

Frequently asked

Common questions about RA biologics.

Quick answers on NICE TA375, TB screening, JAK safety, pregnancy and how the right drug is chosen.

  • When am I eligible for a biologic under NICE TA375?

    NICE TA375 recommends a biologic (bDMARD) for adults with active RA whose disease has not responded to at least two conventional DMARDs including methotrexate. Active is defined as DAS28 above 5.1, or above 3.2 with radiographic damage. A biologic is combined with methotrexate where possible, and continued only if DAS28 falls by at least 1.2 at 6 months.

  • What is the difference between a TNFi, IL-6 blocker, B-cell depleter and JAK inhibitor?

    TNFα inhibitors (adalimumab, etanercept, infliximab, certolizumab, golimumab) block the TNF cytokine and are first-line. IL-6 blockade (tocilizumab) targets a different cytokine and is useful in TNFi failure. Rituximab depletes CD20+ B cells and suits seropositive RA. JAK inhibitors (baricitinib, tofacitinib, upadacitinib, filgotinib) are oral small molecules that block intracellular signalling.

  • How much does a biologic cost me privately in the UK?

    Drug costs run £8,000 to £24,000 per year depending on the molecule and whether a biosimilar is used. Infusion administration is £450 to £850 per session all-in. An initial rheumatology consultation and pre-biologic screening panel is £700 to £1,100.

  • Why do I need TB screening before a biologic?

    TNFα inhibitors, in particular, reactivate latent tuberculosis. Every patient has an interferon-gamma release assay (IGRA) blood test plus a chest X-ray before their first dose. A positive IGRA means at least 4 weeks of isoniazid prophylaxis (continued for 6 months) before the biologic starts. Hepatitis B and C, HIV and a pregnancy test are done alongside.

  • What is the ORAL Surveillance concern with JAK inhibitors?

    ORAL Surveillance was a post-authorisation safety trial that compared tofacitinib with TNFi in RA patients over 50 with at least one cardiovascular risk factor. It showed a higher rate of major adverse cardiovascular events, venous thromboembolism and malignancy with tofacitinib. The signal is now considered a class effect for JAK inhibitors, which means screening is careful and a biologic is usually preferred first in this group.

  • Can I have a biologic if I want to become pregnant?

    Yes, with the right choice. Certolizumab pegol (Cimzia) has minimal placental transfer and is the preferred TNFi in pregnancy and breastfeeding. Etanercept and adalimumab are also considered safe in the first two trimesters. Rituximab, tocilizumab and JAK inhibitors are avoided in pregnancy. Every decision is shared with your obstetrician.

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