[Pharmacotherapy of rheumatoid arthritis]

The therapeutic goals in rheumatoid arthritis have been so far pain reduction, improvement of function and inhibition of disease progression. Nowadays therapeutic strategies must aim at the induction of remission. Long-term results clearly improve with an early start of DMARD therapy. Additional corticosteroid therapy can further reduce joint destruction. After an early start with DMARD therapy (methotrexate in most cases) corticosteroids should be additionally given in moderate and severe cases. Reconsideration of the therapeutic regime should be performed no later than three months after start of therapy. In the case of remission corticosteroids should be reduced. If there is no remission the DMARD therapy should be intensified, if necessary together with a combination therapy. After another three months a step-down concept can be applied if remission occurs. Otherwise therapy should again be intensified, if necessesary with the use of biologicals.