Biologic and targeted synthetic DMARD safety in inflammatory arthritis: British Society for Rheumatology guideline scope

Stephanie F Ling; Joshua L Bennett; Vanessa J Reid; Saad Ahmed; Mostafa Meshaal Ahmad; Sarah Bennett; Marwan Bukhari; Tom Carver; Mary Chatten; Samantha Cooray; Lucy Craig; Cathy Donaghy; James Galloway; Mark Gibson; Rebecca Heaton; Holly Henderson; Nicola Holroyd; Akhila Kavirayani; Alison Kent; Mariam Malik; Andrew Melville; Tanjina Nasrin; Adlan Wafi Ramli; Alan Rawlings; Emily Rose-Parfitt; Luke Sammut; Ethan S Sen; Demisha Vaghela; Angela Vint; Rosemary Waller; Emma L Williams; Taryn Youngstein; Jean Zhang; Sizheng Steven Zhao; Christopher Holroyd; British Society for Rheumatology Guideline Steering Group

doi:10.1093/rap/rkaf104

Biologic and targeted synthetic DMARD safety in inflammatory arthritis: British Society for Rheumatology guideline scope

Rheumatol Adv Pract. 2025 Oct 14;9(4):rkaf104. doi: 10.1093/rap/rkaf104. eCollection 2025.

Authors

Stephanie F Ling¹, Joshua L Bennett², Vanessa J Reid³, Saad Ahmed⁴, Mostafa Meshaal Ahmad⁵, Sarah Bennett⁶, Marwan Bukhari⁷, Tom Carver⁸, Mary Chatten^{9

10}, Samantha Cooray¹¹, Lucy Craig², Cathy Donaghy¹², James Galloway¹³, Mark Gibson¹³, Rebecca Heaton¹⁴, Holly Henderson¹⁵, Nicola Holroyd¹⁶, Akhila Kavirayani¹⁷, Alison Kent¹⁸, Mariam Malik¹⁹, Andrew Melville^{20

21}, Tanjina Nasrin¹⁸, Adlan Wafi Ramli²², Alan Rawlings²³, Emily Rose-Parfitt²⁴, Luke Sammut²⁵, Ethan S Sen^{2

26}, Demisha Vaghela²⁷, Angela Vint²⁸, Rosemary Waller²⁹, Emma L Williams³⁰, Taryn Youngstein³¹, Jean Zhang⁶, Sizheng Steven Zhao¹, Christopher Holroyd⁶; British Society for Rheumatology Guideline Steering Group

Affiliations

¹ Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.
² Paediatric Rheumatology Department, Great North Children's Hospital, Newcastle-upon-Tyne, UK.
³ Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK.
⁴ Department of Rheumatology, Cambridge University Hospital, Cambridge, UK.
⁵ Department of Rheumatology, NHS Fife, Kirkcaldy, UK.
⁶ Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
⁷ Department of Rheumatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK.
⁸ Expert by Experience, Wirral, UK.
⁹ Department of Paediatric Ophthalmology, Queens Medical Centre, Nottingham, UK.
¹⁰ Department of Rheumatology, Queens Medical Centre, Nottingham, UK.
¹¹ Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK.
¹² Department of Rheumatology, Belfast Health and Social Care Trust, Belfast, UK.
¹³ Centre for Rheumatic Diseases, King's College London, London, UK.
¹⁴ Department of Rheumatology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK.
¹⁵ Expert by Experience, Bristol, UK.
¹⁶ North Baddesley Surgery, Southampton, UK.
¹⁷ Department of Paediatric Rheumatology, Oxford University Hospitals NHS Trust, Oxford, UK.
¹⁸ Rheumatology Department, Salisbury NHS Foundation Trust, Salisbury, UK.
¹⁹ Rheumatology Department, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK.
²⁰ Department of Rheumatology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
²¹ School of Infection and Immunity, University of Glasgow, Glasgow, UK.
²² Department of Acute Medicine, Royal Liverpool University Hospital, Liverpool, UK.
²³ Expert by Experience, Stone, UK.
²⁴ Department of Rheumatology, North Bristol NHS Trust, Bristol, UK.
²⁵ Department of Rheumatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
²⁶ Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK.
²⁷ Department of Children's Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, UK.
²⁸ Expert by Experience, Ludlow, UK.
²⁹ Rheumatology Department, Great Western NHS Foundation Trust, Swindon, UK.
³⁰ Rheumatology Department, Hampshire Hospitals NHS Foundation Trust, Winchester, UK.
³¹ Department of Rheumatology, Imperial College Healthcare NHS Trust, London, UK.

Abstract

This guideline will provide up-to-date and evidence-based recommendations for the safe use of biologic and targeted synthetic DMARDs in individuals with inflammatory arthritis (IA) across the life course. Important updates from the 2019 iteration of this guideline will include the incorporation of newer pharmacotherapies (such as Janus kinase inhibitors) and an extension of the target clinical population to cover children and young people with IA. The guideline will be updated and produced in accordance with the British Society for Rheumatology protocol for developing clinical guidelines, updated 2023.

Keywords: DMARD; JAK inhibitor; Rheumatoid arthritis; axial spondyloarthritis; biological therapy; guideline; juvenile arthritis; psoriatic arthritis; safety.

Publication types

Review