Recent advances in the management of rheumatoid arthritis

Abstract

A truly remarkable transformation in RA management has occurred over the past decade. Patient and physician expectation of treatment effect are now high, and management of inflammatory disease and co-morbidity is more readily tailored to individual patient needs. Therapy in rheumatoid arthritis encompasses symptomrelieving drugs (mainly NSAIDS) and DMARDS that retard progression of the disease. Increasingly, the aim of DMARD therapy is to achieve early and sustained suppression of disease activity. Where this can be achieved NSAIDS could potentially be discontinued. The rapid expansion of available therapies for RA over the past decade is exciting, but necessitates constant re-evaluation of treatment goals and toxicity profiles. It may be that the early use of DMARDS including anti-TNFa drugs will render NSAIDS and corticosteroids unnecessary. Early, sustained and intensive treatment will hopefully improve medium and long-term outcomes in RA. In this review we outline issues that have arisen with the use of NSAIDS and advances in the use of existing DMARDS. In addition, currently available biological agents and those in development are also discussed.