Safety of Treatment Options for Spondyloarthritis: A Narrative Review

The 2018 narrative review on the safety of treatment options for spondyloarthritis (SpA) concluded that both conventional and biological drugs generally have a good safety profile, with serious adverse events being rare. The review emphasized the need for clinicians to monitor for adverse events and to select treatments based on individual patient risk factors to minimize adverse outcomes. NSAIDs were found to be safe over 12 weeks, and methotrexate (MTX) side effects could be mitigated with folate. The risk of adverse events from DMARDs was higher in psoriatic arthritis (PsA) than in rheumatoid arthritis (RA), and MTX should be used cautiously in patients with renal insufficiency and is contraindicated during pregnancy. A 2016 observational study involving 618 patients with PsA treated with conventional synthetic DMARDs and TNF inhibitors over 9 years found a 7.1% incidence of malignancies, with age as the only predictor. The review also discussed the safety of biologic DMARDs, noting specific risks associated with TNF inhibitors and other agents, and highlighted that many treatments can be considered during pregnancy and breastfeeding, with some exceptions. The authors called for a tailored approach to treatment and better monitoring for adverse events, as current recommendations do not adequately address this aspect. The review did not provide specific numbers of participants for the studies cited, as it was a narrative review summarizing various sources.