[New therapy approaches in rheumatoid arthritis. Preventing early joint destruction]

New perceptions about the cellular and molecular interactions involved in the inflammatory process have created a basis for specific treatment of rheumatoid arthritis. The therapeutic arsenal has now been expanded to include more selective inhibitors of cyclooxygenase, antibodies and antagonists of the cytokines, and an inhibitor of pyrimidine synthesis. Large clinical trials have demonstrated the efficacy of early immunomodulatory treatment aimed at preventing joint destruction, as well as the superiority of the combination therapy over monotherapy with a long-acting antirheumatic agent. To date, uniform criteria for the evaluation of the results of treatment are, however, lacking.