[Treatment of active rheumatoid arthritis]

The currently available treatments allow to foresee a remission or at least a low activity disease for rheumatoid arthritis (RA). As soon as the diagnosis is done, a DMARD (Disease Modifying Anti-Rheumatic Drug) has to be introduced, and generally methotrexate is proposed as first line. In case of inadequate response to MTX or to other DMARD, an association to a biologic has to be considered. Nine biologic agents are now available for the treatment of RA: 5 inhibitors of TNFalpha, 1 anti-ILl, 1 anti-IL6 receptor, 1 inhibitor of T cell activation and 1 monoclonal antibody able to deplete B cells. Biologic agents are associated to an increased risk of severe infections which have to be prevented by looking for latent tuberculosis infection and by vaccinations. Glucocorticoids have to be used cautiously because of their numerous and sometimes severe side effects. Patients have to be advised against smoking.