Refining drug safety in rheumatology.

This issue explores several important safety concerns that currently plague the rheumatologist and health care providers who care for patients with rheumatic diseases. Weighing safety against efficacy can be a complex task that is best alleviated by understanding the issues, nature, and breadth of problems associated with drug use. Therapeutic decision-making must be evidence-based, judicious, and appropriate for the patient and situation. Understanding drug safety is paramount to ensuring both success of therapy and benefit to the patient. Similarly, it is important not to underestimate the impact of uncontrolled disease activity in decision-making. Drug safety must be weighed against the severity and risks of the disease under treatment. Clearly the benefit/risk ratio has improved for many of the therapies discussed in this book. The use of both conventional and novel therapies mandates an understanding of the mechanisms of action, unique toxicities, screening and monitoring measures, and rules for drug avoidance.