How safe is it to take Remicade on a 54 yr old female who has fought RA for 53 years

It would seem as if you have severe RA and have failed other potent medications. Most rheumatologists, myself included, would advise you to start treatment with a TNF inhibitor. If you do not have coverage for self-administered medications such as Enbrel or Humira, then Remicade would be appropriate as it is administered in the office or in the hospital and is usually covered by Medicare. Remicade has about a 60-70% chance of improving your pain and function.

Infection is the major risk associated with TNF blockers. The risk of serious infection is about 2 times what it would be without a TNF blocker. However, the risk of infection of taking even 5mg of predisone approaches that of the TNF inhibitor. If you were to take Remicade, then you may be able to decrease or even eliminate prednisone altogether which would limit your risks.

The risk of cancer is not increased with TNF blockers except perhaps for skin cancer. Patients with RA have an increased risk of lymph gland cancer called lymphoma. The risk is greater in patients with more severe RA. It is not clear if TNF blockers increase this risk further.

On balance, TNF inhibitors are effective and well-tolerated and should be given serious consideration in someone like yourself with progressive RA.