RA101: Managing side effects of treatments for RA

If you or a loved one is taking medications for rheumatoid arthritis (RA), you should know about some potentially serious side effects which a number of these medications have in common.1

These side effects include reactivating tuberculosis, serious infections, and in rare cases, cancer. If could help doctors and nurses if they are alerted to these side effects as early as possible.1

Side effects Guideline recommendations
Reactivation of tuberculosis

If you or a loved one has a history of tuberculosis or TB, biologic and targeted DMARDs can trigger its reactivation.1-4

Symptoms may include a persistent cough and/or fever.


Before starting treatment, talk to your doctor about testing for tuberculosis or TB. If it’s positive, have it treated before starting on a biologic or targeted DMARD.6

Serious infections

Both biologic and targeted DMARDs pose a greater risk of serious infections than conventional DMARDs.3-6

This is of concern for all biologic and targeted DMARDs because they suppress white blood cells to help control symptoms of RA.

Depending on where the infection occurs, symptoms may include coughing, itchy/swollen skin, and painful urination.


While all biologic and targeted DMARDs may increase the risk of serious infections, consider avoiding certain biologic DMARDs called TNF inhibitors if you or a loved one has a history of serious infections.6

TNF inhibitors include Humira (adalimumab), Cimzia (certolizumab pegol), Enbrel (etanercept), Simponi (golimumab), and Remicade (infliximab).6


Cancer is a rare side effect of biologic and targeted DMARDs.3-6

Symptoms may include unexplained fatigue, loss of appetite, unusual bleeding, and unusual growths on the skin.


If you or a loved one has a history of:6

  • Skin cancer: consider avoiding biologic and targeted DMARDs
  • Lymphoma: consider avoiding TNF inhibitors listed above

These are not all the side effects that can occur. As a rule of thumb, always tell the doctor or nurse about unexpected symptoms and effects of your treatment.

To learn more:


References: 1. Smolen JS, et al. Lancet 2016. Published online: May 3, 2016. 2. UpToDate. Patients information: Rheumatoid arthritis treatment (beyond the basics). Available at http://www.uptodate.com. Accessed on May 05, 2016. 3. Tofacitinib Prescribing Information, 2015. 4. Genovese MC, et al. N Engl J Med 2016;374:1243-52. 5. Singh JA, et al. Lancet 2015;386:258-65. 6. Singh JA, et al. Arthritis Care Res 2015;68(1):1-25.

Last updated: September 17, 2016.
Photo adapted from original by Jamie, used under license.

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