Drug treatment for rheumatoid arthritis

The general goals of drug treatment for patients with rheumatoid arthritis are to reduce morbidity and mortality. Because rheumatoid arthritis is a potentially devastating disease, a more aggressive treatment approach has emerged in the last decade. The modern treatment pyramid consists of nonsteroidal antiinflammatory drugs and glucocorticoids for symptomatic relief, and disease modifying antirheumatic drugs for reducing disease activity in the short term and joint damage in the long term. There is increasing evidence that a reduction of disease activity by disease modifying antirheumatic drugs alters the course of rheumatoid arthritis and that patients benefit from early installation of these compounds. The major problem with disease modifying antirheumatic drugs is their low efficacy to toxicity ratio, leading to marked reduction of the length of time a patient is taking a given drug. The new treatment strategies, including combination regimens and new drugs that are being investigated, promise better efficacy and tolerance in the near future. A step in this direction is the development of biologic agents targeting specific mechanisms in the immune response. Early results in clinical trials with antitumor necrosis factor-alpha monoclonal antibodies are encouraging.