A new era in rheumatoid arthritis treatment

Rheumatoid Arthritis (RA) is a systemic autoimmune disease that primarily manifests as a chronic symmetric polyarthritis. Treatment in the past was aimed at symptomatic pain relief. The initiation of disease modifying anti-rheumatic drugs (DMARDs) was historically started only after significant disease activity was present in order to reduce side effects from drug toxicities. Unfortunately, irreversible joint damage may occur early in the disease course. Evidence of bony destruction is common on radiographs within the first 2 years after disease onset. Therefore, more aggressive treatment became the standard with earlier introduction of DMARDs in hopes of preventing joint destruction. Within the past few years, greater understanding of the pathophysiology of RA has permitted development of therapies targeted at specific cytokines. Tumor Necrosis Factor-alpha (TNF-alpha) is a pro-inflammatory cytokine believed to play a key role in the inflammatory response in RA. Three drugs--etanercept, infliximab, and adalimumab--are anti-TNF-alpha agents approved in the United States for the treatment of RA. This article is a review of indications, clinical trials, and toxicities of these 3 agents.