[New perspectives in the treatment of rheumatoid arthritis]

Rheumatoid arthritis affects 0.5% of the Spanish population. It is a disabling, slowly progressive disease which primarily affects joints, and results in functional impairment and important quality of life reductions in most patients. Its etiology is presently unknown. Treatment is aimed at reducing inflammatory activity, preserving function, and delaying joint lesions, which result in high morbidity and mortality. Treatment is usually initiated with NSAIDs and glycocorticoids to relieve symptoms, and then followed by disease-modifying anti-rheumatic drugs. Recent advances in the understanding of etiopathogenic mechanisms have permitted the development of novel, much more specific treatments aimed at modifying disease progression. These include those acting on the tumoral necrosis factor (TNF) - etanercept and infliximab - and more recently an interleukin-1 receptor antagonist - anakinra. Despite their demonstrated improved tolerance and faster onset of action, their high cost warrants further efficacy studies and the establishment of objective criteria for their use.