How to Use Janus Kinase Inhibitors in the Treatment of Rheumatoid Arthritis? A Clinical Assessment of Risks and Benefits

Curr Rheumatol Rep. 2023 Dec;25(12):295-306. doi: 10.1007/s11926-023-01122-9. Epub 2023 Dec 16.


Purpose of review: To provide an updated understanding of risks and benefits of Janus kinase inhibitors (JAKi) versus biologic disease-modifying antirheumatic drugs (bDMARDs) in the management of rheumatoid arthritis (RA).

Recent findings: Shared decision-making is needed in choosing between JAKi and bDMARDs. Cardiovascular disease, malignancy, and thromboembolic events guide this choice. In patients with active RA despite methotrexate use, tumor necrosis factor inhibitor is conditionally favored over JAKi for low-cardiovascular-risk patients and strongly favored in those with pre-existing cardiovascular disease or multiple cardiovascular risk factors. Suboptimal treatment of treatment-refractory RA patients may pose a greater absolute cardiovascular risk than with JAKi use. Use of aspirin and statin may be considered to reduce cardiovascular risk. New safety data on JAKi has redefined the treatment approach in RA. JAKi remains an important oral medication option in active RA despite treatment with bDMARDs, especially in those with low cardiovascular risk.

Keywords: Janus kinase inhibitor; Rheumatoid arthritis; Targeted synthetic DMARD; Tumor necrosis factor inhibitor.

Publication types

  • Review

MeSH terms

  • Antirheumatic Agents* / adverse effects
  • Arthritis, Rheumatoid* / drug therapy
  • Cardiovascular Diseases* / etiology
  • Cardiovascular Diseases* / prevention & control
  • Humans
  • Janus Kinase Inhibitors* / adverse effects
  • Risk Assessment


  • Janus Kinase Inhibitors
  • Antirheumatic Agents