Medications that slow down the progression of the disease rheumatoid arthritis are called disease-modifying anti-rheumatic drugs, or DMARDs, according to the University of Maryland Medical Center. Some DMARDs, called biologic agents, target specific parts of the immune system that are involved in inflammation. While biologics are important in the management of rheumatoid arthritis, there are some risks associated with these medications.
Injection Site Reactions
One of the most common risks of biologic agents in the treatment of rheumatoid arthritis is an injection site reaction, according to American College of Rheumatology. These skin reactions affect about 30 percent of patients and are typically limited to the area around the injection site. For some biologic medications such as the anti-tumor necrosis factor agents, adalimumab and etanercept, the reactions may last up to one week; for other biologic medications such as anakinra, the rash may last up to two weeks.
Increased Risk of Infection
Since biologic agents work on the immune system, patients who take these medications are at higher risk of developing an infection or reactivating an inactive infection, according to the University of Maryland Medical Center. Patients who have had tuberculosis or chronic hepatitis in the past should not take these biologic agents because the infection may flare up again. Patients should be screened for these infections prior to beginning biologic therapy and if a patient develops a high fever during therapy, the biologic may need to be discontinued until the infection has been treated.
Cancer
Patients taking biologic agents may be at high risk for certain types of cancers. The risk of lymphoma is increased in patients with rheumatoid arthritis, according to the health care information website UpToDate. The use of the anti- tumor necrosis factor agents--etanercept, infliximab, and adalimumab--may increase the risk of lymphoma and should not be used by patients with a history of lymphoma, according to University of Maryland Medical Center. These agents may also be associated with an increased risk of non-melanoma skin cancers as well.
Congestive Heart Failure
Certain biologics are not recommended for patients with congestive heart failure and rheumatoid arthritis, notes Johns Hopkins Arthritis Center. According to K. M. Cordoro, MD and S. R. Feldman, MD in a 2007 article published on SkinTherapyLetter.com, reports have shown that patients without congestive heart failure have developed the disease while taking the anti-tumor necrosis factor agents. Etanercept, infliximab and adalimumab are generally not used in patients with congestive heart failure because of the risk of worsening the condition.
Demyelinating Diseases
Biologic agents increase the risk of neurologic complications in some patients, according to the American College of Rheumatology. The use of anti-tumor necrosis factor agents such as etanercept, infliximab and adalimumab has been associated with exacerbations of multiple sclerosis in patients, according to Cordoro and Feldman. Patients with multiple sclerosis or optic neuritis should not use these therapies.
