[Armentarium and strategies for the treatment of rheumatoid arthritis]

Rheumatoid arthritis is characterized by chronic synovitis resulting in bone and joint destruction in various delays, and ultimately leading to handicap. Remission can be induced at the beginning of the disease. It is well established that slow-acting remitting drugs can efficiently halt radiological progression and improve functional outcome. Besides symptomatic agents (NSAID, steroids, joint injections and synoviorthesis), several long-acting treatment strategies have been proposed based upon methotrexate, alone or in combination with sulfasalazine, hydroxychloroquine, and also anti-TNF agents. Several strategies have been compared according to the disease profile, and suggested that both combination and mainly tight control of the disease clearly improve the clinical, radiological and functional outcomes. The indication of anti-TNF agents is still discussed case by case with respect to treatment failure and risk-benefit ratio at mid and long term. General practitioners should contribute to an early management and regular follow-up by rheumatologists and to general managements of comorbidities.