The Effects and Safety of Conventional Synthetic DMARDs in Rheumatoid Arthritis

ABSTRACT: Objective: The purpose of this study was to assess the effectiveness and safety of conventional synthetic DMARDs (csDMARDs) for treating rheumatoid arthritis (RA), including clinical outcomes and adverse drug reactions (ADRs). Methods: An observational study of 51 adult RA patients treated with csDMARDs was carried out at Bangalore Baptist Hospital. Clinical measures such as pain score, Disease Activity Score (DAS28), Erythrocyte Sedimentation Rate (ESR), and C-reactive protein (CRP) levels were evaluated at baseline and 6 months later. Safety was assessed by tracking ADRs and drug discontinuation rates. Results: There were notable reductions in pain scores (from 7.07 to 3.19), DAS28 scores (from 4.97 to 3.02), ESR (from 58.6 to 28.32), and CRP levels (from 50.5 to 18.5), indicating significant clinical improvements. The most commonly given csDMARDs were methotrexate (21.56%) and hydroxychloroquine (66.66%). The most common adverse events (ADRs) that resulted in drug discontinuation were pancytopenia, ototoxicity, transaminitis, and rashes, accounting for 23.52% of patient cases. With moderate to high effect sizes of 0.62 and 0.60, respectively, the intervention considerably decreased both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Pain scores fell by 1.32 with a moderate impact size (0.49), however the Disease Activity Score (DAS) decreased with a substantial effect size (0.66). Each change was statistically significant (p < 0.05 for pain; p < 0.001 for DAS, CRP, and ESR). Pre- and post-intervention measurements of ESR (r = 0.48), CRP (r = 0.51), pain (r = 0.40), and DAS (r = 0.62) showed moderate to high relationships. Conclusion: csDMARDs continue to be beneficial in RA management, with reports of noteworthy reductions in disease prevalence and life quality. Nevertheless, close observation and control are required due to the ADR risk. To improve safety and efficacy, future research should prioritize improving therapy regimens and investigating new therapeutic options. Keywords: hydroxychloroquine, methotrexate, csDMARDs, rheumatoid arthritis, adverse drug reactions, disease activity score, and clinical outcomes