Are biologic agents recommended in rheumatoid arthritis (RA) with chronic heart failure?

Updated: Feb 07, 2020
  • Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD  more...
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Anti−tumor necrosis factor (TNF) biologic agents are not recommended in RA patients with New York Heart Association (NYHA) congestive heart failure (CHF) class III (cardiac disease causing marked limitation of physical activity; less than ordinary physical activity causing fatigue, palpitation, dyspnea, or anginal pain; asymptomatic at rest) or IV (cardiac disease causing inability to carry on any physical activity without discomfort; presence of symptoms of cardiac insufficiency or angina syndrome at rest, which increase with physical activity) who have an ejection fraction of 50% or less. ACR recommends combination DMARDs or non-TNF biologic agents or tofacinitib over anti-TNF agents.

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