Since inflammation is a component of rheumatoid arthritis, medications can sometimes alter a person’s immune system functions.

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For many people with rheumatoid arthritis, the benefits from medications outweigh the risk of toxic side effects. Getty Images

“Serious and sometimes fatal infections and cancers can occur.”

In most instances, a phrase such as this would raise more than one red flag.

But these types of warnings are common parts of the advertisements associated with certain types of drugs used to treat rheumatoid arthritis.

There’s a reason.

“Rheumatoid arthritis symptoms include joint swelling pain, stiffness, inability to close a tight fist, hand grip weakness, and more. The symptoms can be functionally very limiting,” Dr. Tarun Sharma, a rheumatologist at the Lupus Center of Excellence in Pittsburgh, Pennsylvania, told Healthline.

Depression, he adds, is another potential symptom or comorbidity of rheumatoid arthritis (RA).

“In some instances, the immune system could be revved up to an extent leading to significant levels of fatigue as a byproduct of high levels of inflammation,” Sharma explained.

While many people are aware that inflammation is a component of RA, this immune system involvement is exactly why some rheumatoid arthritis medications have the potential to be toxic.

Biologic and biosimilar drugs, along with immunosuppressants, are powerful medications that alter the function of the immune system.

Any time a part of the immune system is biologically changed, risks are raised.

Sharma explains that with any medication — or surgery for that matter — comes a risk versus benefit analysis that the doctor and the patient need to consider.

So with all this in mind, the question becomes: Is the potential toxicity of RA medications worth the risk?

It depends on who you talk to or what research you read.

When mindfully dispensed under the care of a reputable healthcare provider, modern RA drugs can greatly improve the quality of life, mobility, and prognosis for people living with rheumatoid arthritis.

These drugs also undergo in-depth scrutiny — including layered phases of development and multiple clinical trials that test for safety and efficacy — in order to be brought to market in the United States.

Some people are understandably leery about drug warnings such as “inhibits your ability to fight infections… tell your doctor if you have been to areas where serious fungal infections are common.”

In fact, a recent report indicated that the toxicity of RA drugs may be more dangerous than once thought.

A story in the Milwaukee Journal Sentinel reported that the biological medications on the market used to treat rheumatoid and psoriatic arthritis have been linked to 34,000 deaths in the past 15 years.

These deaths only account for those that have both been linked to drugs and reported to the Food and Drug Administration (FDA) since the year 2004.

Some of the deaths were shown to have a direct correlation to these types of drugs.

Other deaths, such as those from cardiovascular events, could be a result of either the drug or the illness itself.

Many of the instances of infection were due to the immune-compromising factors associated with these complex drugs.

These include medications such as Remicade, Enbrel, Humira, Simponi, and Xeljanz, and a whole array of other pharmaceuticals used to treat RA, psoriatic arthritis, and cancer.

So what is the answer? As with many complexities surrounding RA, the answer is unclear.

Experts say it can start with improved screenings for common cancers and infections associated with these diseases. Regular lab work and routine blood tests are a good place to start.

But other areas need to be monitored, too.

A recent study showed that only 26 percent of people with RA were properly or effectively screened for infection during the time of their treatment.

“More robust safety protocols are urgently needed to prevent serious patient safety events in this high-risk population,” the study, published last year in the Joint Commission Journal on Quality and Patient Safety, concluded.

Guidelines that rheumatologists must follow also note that people taking high-risk medications must be closely monitored.

Pharmaceutical companies are required to report adverse events to the FDA — and consumers are encouraged to self-report, too.

According to the FDA website, “The FDA Adverse Event Reporting System (FAERS) is a database that contains adverse event reports, medication error reports, and product quality complaints resulting in adverse events that were submitted to FDA.”

The Arthritis Foundation says that people needn’t worry too much. Their website proclaims that “side effects can occur, but the risk also can be overestimated.”

Maria Grosley, an Ohio resident with rheumatoid arthritis and osteoarthritis, says the risk is worth it for her.

“I normally think better safe than sorry,” she told Healthline. “I know that I have pain and I know some RA meds can be toxic or that some people think they’re unsafe. So I do want to know about risks of death or side effects. I want to have that information and be aware of it.”

“But that said, I won’t dwell on it or let it persuade me to go off my medications,” she added. “I need them and they help me, that’s all there is to it. So I play it safe within reason. I’m not going to go off them and suffer because I’m afraid, when they could be what allows me to thrive and survive.”