The introduction of biological disease-modifying antirheumatic drug (bDMARD) 
treatments for various types of autoimmune arthritis, such as rheumatoid 
arthritis, psoriatic arthropathy and ankylosing spondylitis, represents a new 
era of treatment for patients with a refractory response to conventional 
synthetic DMARDs (csDMARDs). Many new bDMARDs with different modalities or that 
target different pro-inflammatory molecules, likely cytokines, are rapidly 
emerging. Hence, physicians in the field may be confused about choosing 
appropriate bDMARDs for their patients. Considering the high cost of bDMARDs and 
the rapid destructive process of autoimmune arthritis in patients, the choice of 
optimal bDMARDs for patients who fail to respond or show an inadequate 
therapeutic response to csDMARDs designed to control the disease is very 
critical. Here, we summarize the strengths and weaknesses of bDMARDs and 
specifically focus on their uses in patients with comorbid conditions or with 
specific medical conditions, such as pregnancy. This commentary provides a solid 
up-to-date review on commercially available bDMARDs and very useful information 
for physicians to facilitate the choice of more appropriate bDMARDs to treat 
patients with autoimmune arthritis and for basic researchers to understand the 
current strategies of bDMARD usage and hopefully to develop more powerful 
bDMARDs with fewer safety concerns.