Are disease-modifying anti-rheumatic drugs (DMARDs) a safe, long-term treatment for rheumatoid arthritis?

This study analyzed the safety of disease-modifying anti-rheumatic drugs (DMARDs) for the treatment of rheumatoid arthritis (RA).

They found that patients taking biological DMARDs had a higher risk of infections compared to synthetic DMARDs.

Rheumatoid arthritis (RA) is an auto-immune condition which causes degeneration of joint tissue, chronic pain and inflammation. Disease-modifying anti-rheumatic drugs (DMARDs) are medications which treat RA. These can be biological (naturally occurring) or synthetic.

DMARDs have been well studied in clinical trials. However, many trials focus on short-term drug effects. Long-term safety of administering DMARDs has been less well studied.  

This study analyzed data from several reports of DMARD use in RA to investigate safety. This study included data from 26 clinical reports. Patients in these studies were treated with either biological or synthetic DMARDs. The side effect profile from each patient was examined.

There was an increased risk of infection in patients taking biological DMARDs compared to synthetic DMARDs (10-80%). Biological DMARDs were also associated with an increased risk of tuberculosis (approximately 3- to 12-fold) and melanoma (50%) compared to synthetic DMARDs. 

This study concluded that biological DMARDs were associated with a greater risk of infection compared to synthetic DMARDs.

The studies which matched the inclusion criteria focused primarily on biological DMARDs. The study did not include glucocorticoids which are a popular treatment and long-term safety is unknown. 

Please discuss any concerns regarding DMARDs with your physician.