Treatment Considerations for Selecting Biologic and Targeted Synthetic DMARDs in Patients with Rheumatoid Arthritis with Comorbidities: An Indian Perspective

Comorbidities impact the management and outcomes of patients with rheumatoid arthritis (RA). In Indian patients, RA is frequently accompanied by comorbidities/medical conditions such as hypertension, diabetes, kidney disorders, anaemia, obesity, osteoporosis and infections, all of which can significantly influence treatment decisions. Biologic and targeted synthetic disease-modifying antirheumatic drugs (b/ts DMARDs) have transformed RA management by achieving rapid and sustained disease control. However, the presence of comorbidities often complicates the selection and safe use of these therapies in routine practice. Most randomised controlled trials, which form the basis of global recommendations, exclude patients with medical conditions such as cardiovascular disease, chronic liver or kidney dysfunction, malignancy and latent infections, thus reducing the relevance of the study findings to real-world, high-risk populations seen in routine Indian practice. Currently, there are no India-specific guidelines for the use of b/ts DMARDs in RA complicated by comorbidities/medical conditions. In this article, we present a review of the evidence to inform treatment considerations for managing RA, tailored to clinical challenges, that can assist clinicians in navigating therapeutic choices in complex comorbidity profiles.