Need to know

Rheumatoid arthritis is a chronic multisystem autoimmune disease with significant potential impacts on quality of life and function. 

However, over the last two decades the outcomes with rheumatoid arthritis (RA) have improved dramatically, in part due to treatment with biologic disease modifying antirheumatic drugs (bDMARDs). Methotrexate and other conventional synthetic DMARDs remain first-line therapy for patients with moderate to severe disease. However, their limited efficacy and side effect profile, including gastrointestinal upset and potential for liver toxicity and haematological changes, necessitated establishment of further therapies for RA.¹ Thus bDMARDs and targeted synthetic DMARDs were developed and have now altered the entire therapeutic landscape.² As a consequence, unprecedented improvements have been seen in the signs and symptoms of disease, patient reported outcomes and radiographic damage. Currently the goal of management is remission, a concept that was unimaginable 20 years ago. 

Given the increasingly important role of bDMARDs in managing RA, it is essential that clinicians are aware of these agents and their well characterised adverse effect profiles. This article will focus on the key side effects of which to be mindful, and also highlight the critical role of primary care in monitoring patients with RA who require these advanced therapies.