Biologics in early rheumatoid arthritis

Treatment of patients with rheumatoid arthritis (RA) with disease-modifying antirheumatic drugs is started immediately after diagnosis, resulting in more effective suppression of disease activity and substantial reduction of joint damage. The development of biologic agents has enabled remission as a realistic therapeutic goal in a greater proportion of patients. The tumor necrosis factor-alpha inhibitors, infliximab, etanercept, and adalimumab, have been studied in numerous randomized clinical trials. These agents can suppress disease activity directly, slow or stop progression of radiologic damage, and prevent further loss of quality of life. Patients treated with tumor necrosis factor-alpha inhibitors show few adverse events, which together with the high clinical effectiveness is favorable for treatment compliance. The exact role of these agents in the treatment of early-stage RA is unknown.