Adalimumab for the treatment of rheumatoid arthritis

Rheumatoid arthritis (RA) is characterized by massive synovial proliferation resulting in joint destruction and deterioration in quality of life. TNF-alpha has been implicated in the central pathogenesis of RA, and its blockade? by anti-TNF-alpha monoclonal antibodies (infliximab and adalimumab) and the soluble TNF-alpha receptor (etanercept) has caused a paradigm shift in the treatment of RA. Adalimumab can be used alone or concomitantly with methotrexate, but the combination of both is significantly superior to monotherapy with adalimumab. Adalimumab can not only ameliorate the signs and symptoms of the disease, but can also inhibit the progression of joint destruction and improve quality of life. Approximately 50% of patients with early, aggressive RA receiving combination therapy with adalimumab and methotrexate can be introduced into disease remission (disease activity score < 2.6). Adalimumab is even effective in patients with RA treated previously with other biologics. Long-term treatment with adalimumab is safe and well tolerated in patients with RA.