Treatment options for rheumatoid arthritis

Over the last several decades, approaches to the management of rheumatoid arthritis (RA) have been empirical. Subsets of RA patients respond well to traditional disease-modifying antirheumatic drugs (DMARDs), either as single therapy or in combination. However, a significant population remains untreated or undertreated. The lessons learned from DMARD strategies have led to stratification of patients based on observed or expected disease progression. At the same time, clinicians have gained a better understanding of the immunology and immunopathophysiology of RA. The advent of monoclonal antibody technology and other advances in biotechnology have resulted in the development of agents that target specific components of the immune response. Recent trials with 2 antitumor necrosis factor alpha (TNF alpha) chimeric antibody agents, etanercept and infliximab, have shown promising results, both as proof of concept and in more rigorous clinical trial populations leg, patients who are refractory to (DMARDs). Future directions include combination DMARD/biologic agent therapy, and other molecular strategies targeted to parts of the immune response that appear to be dysregulated in RA patients. Stratifying patients will hopefully lead to more tailored and targeted therapies and a more cost-effective approach to RA management.