New approaches to the management of rheumatoid arthritis

The approach to the treatment of rheumatoid arthritis is currently undergoing fundamental change. The demonstration of erosions by magnetic resonance imaging early in the disease, when conventional radiographs only show soft tissue swelling, demands rapid intervention with more effective drugs. The increasing use of methotrexate earlier in the course of the disease is justified, in view of the favorable benefit/risk ratio. New experimental therapies, such as photopheresis, the fusion protein, DAB486 interleukin 2, FK 506, and monoclonal CD4+, may also be utilized earlier if their safety profiles permit. Conventional therapeutic regimens are being administered differently in an attempt to improve efficacy and safety.