Therapeutic Strategies for Rheumatoid Arthritis

• Published in: The New England journal of medicine Vol. 350; no. 25; pp. 2591 - 2602
• Main Authors: Wood, Alastair JJ, O'Dell, James R
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 17.06.2004
• Subjects: Adrenal Cortex Hormones - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - therapy; Autoantibodies - blood; Autoimmune diseases; Biological and medical sciences; Citrulline - immunology; Comorbidity; Cytokines; Diseases of the osteoarticular system; Drug Therapy, Combination; General aspects; Humans; Inflammatory joint diseases; Medical research; Medical sciences; Prognosis; Rheumatoid arthritis; Rheumatoid Factor - blood; Medicine; Immunopathology; Chronic; Treatment; Rheumatoid arthritis; Diseases of the osteoarticular system; Autoimmune disease; Strategy; Inflammatory joint disease
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMra040226

A better understanding of the pathophysiology of rheumatoid arthritis, together with influential trials aimed at treating early stages of the disease, has altered therapy. This article considers approaches that have resulted in markedly better clinical outcomes, including early diagnosis and treatment; the advent of combinations of disease-modifying antirheumatic drugs and agents that target cytokines; and recognition and treatment of important coexisting conditions, particularly cardiovascular disease and osteoporosis. A better understanding of the pathophysiology has altered therapy. Rheumatoid arthritis, a chronic, systemic, inflammatory autoimmune disease, has as its primary target the synovial tissues. When the disease is unchecked, it leads to substantial disability and premature death. 1 It affects approximately 0.8 percent of adults worldwide, 2 is more common in women (by a ratio of 3 to 1), and has an earlier onset in women, frequently beginning in the childbearing years. 3 Recent advances in understanding the cytokine networks that are responsible for the ongoing inflammatory response in rheumatoid arthritis 4 have led to the successful use of therapies that target tumor necrosis factor α (TNF-α) and interleukin-1. 5 (These therapies were . . .