Many rheumatology patients have heard of the word “biologics”, but because of its high price, the entire rheumatology population still accounts for a minority of weight use, so many patients and friends feel that he is very “mysterious”. Therefore, there are many rumors about biologics. Some people think that using biologics is the “last resort” and other drugs will not work after using them; some people think that biologics have a lot of side effects and should not be tried easily; of course, some people think that its “effect is powerful” and it is the most effective treatment for rheumatism. “, is the “magic pill” of rheumatism treatment …… In fact, these perceptions are incorrect. So what exactly is a biological agent? What is his role and scope of application? This article will give you a correct understanding of biological agents. Simply put, in the field of rheumatology, biologics are actually monoclonal antibodies manufactured using biotechnology. At present, the rheumatology department has more applications: rheumatoid arthritis, ankylosing spondylitis, spondyloarthropathy, psoriatic arthritis, leukoarthrosis, etc. We know that the cause of rheumatic diseases is often unknown, but current research has shown that certain important factors are involved in the development of these rheumatic diseases. For example, the development of rheumatoid arthritis is closely related to “tumor necrosis factor alpha” and “interleukin 6”, and ankylosing spondylitis is closely related to “tumor necrosis factor alpha”. –We will call these factors “crime factors”. Traditional drugs such as methotrexate and leflunomide are used to suppress these factors by inhibiting the lymphocytes, which are the producers of these factors. Unfortunately, after suppressing the lymphocytes, the production of criminal factors is reduced, but the “good factors” that the body needs are also reduced, thus bringing adverse effects such as bone marrow suppression and liver function damage, and the effect is not good for some patients because traditional drugs are difficult to achieve “precise strikes”. If we use a war analogy, traditional drugs such as leflunomide and methotrexate are more like “carpet bombing” – they are powerful but not precise enough and may accidentally injure civilians. Unlike biologics, which are the “precision-guided weapons” of drugs, they can deliver “precision strikes” against criminal elements. As a result, they are often fast-acting and highly effective, and some patients who do not respond well to traditional drugs (leflunomide, methotrexate, etc.) can also achieve good results. Compared to traditional drugs, biologics also have significantly fewer adverse effects such as bone marrow suppression and liver function impairment. However, unfortunately, “biologics” are relatively expensive; although the overall efficiency is greater than that of traditional drugs, they are not effective for everyone, and the risk of infection is slightly higher than that of traditional drugs, which also limits their application to a certain extent. After the above introduction of biological agents, then in what cases we need to choose biological agents? 1, the disease is more serious: biological agents have a fast onset of action, high total efficiency, for rheumatoid arthritis, ankylosing spondylitis is more serious or the onset of the disease is very urgent, can first biological agents – this is similar to the war when the Americans are always the first to the enemy to carry out precise air strikes. The heavy blows are used to control the disease at once and then gradually overtake the treatment with conventional drugs. The common cases of heavy disease are: rheumatoid arthritis generalized multi-joint swelling and pain, systemic inflammatory response heavy; rheumatoid arthritis exists extra-articular manifestations; ankylosing spondylitis with fever (inflammatory storm); ankylosing spondylitis hip joint involvement (will directly affect future walking); leukoarthritis combined with leuko-intestinal disease, leukoencephalopathy, and so on. 2, traditional drug treatment is not good: traditional drug treatment is not good for patients can be replaced by biological treatment to achieve relief, to protect the function of the joint / spine. Poor traditional drug therapy is common in the following cases: (1) patients with rheumatoid arthritis whose condition does not decrease after 3 months of traditional drug therapy or does not remit after 6 months (both still have >1 joint swelling and pain). (2) Patients with ankylosing spondylitis who still have pain and stiffness in the low back after 1 month of treatment with nonsteroidal anti-inflammatory drugs (e.g. Ciloxib, meloxicam, etoricoxib, etc.). (3) Those whose condition is not well controlled in other cases. (3) Those who have side effects with traditional drug therapy: traditional drugs often have some adverse reactions: such as liver function damage, white blood cell reduction, affecting menstruation, pulmonary fibrosis, etc. Patients who cannot use traditional drugs because of such side effects can patient unbiologic treatment. The above briefly introduced what is a biological agent, his advantages and disadvantages, his scope of application, I think we must have a new understanding of biological agents. Finally, I would like to tell our patients that biologics and traditional drugs are weapons in the hands of rheumatologists, and they play a great role in the war against the disease, and are not interchangeable. There is no such thing as “if you use biologics, traditional drugs are no longer effective”. They can be used interchangeably depending on the disease. Finally, I hope that patients will listen to the doctor’s guidance and choose the correct use of drugs, so that they will not listen to rumors and harm themselves. Dr. Xie Yu welcomes your comments and I will try my best to answer your questions when I have time.