[Therapeutic update in rheumatoid arthritis].

Area of Science:

• Rheumatology
• Immunology
• Pharmacology

Context:

• Biologic agents have revolutionized rheumatoid arthritis (RA) management, shifting treatment paradigms towards achieving remission.
• Current EULAR and ACR recommendations emphasize early and aggressive treatment strategies, including "treat to target".

Purpose:

• To review the current landscape of biologic therapies for RA, including their mechanisms of action and safety profiles.
• To discuss the strategic considerations for prescribing biologics in RA, considering efficacy, safety, and patient comorbidities.

Summary:

• Disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate (MTX), remain foundational, often used with symptomatic treatments and corticosteroids for flares.
• Biologics targeting various pathways (anti-TNFα, IL-1, IL-6, CD20, CTLA-4) offer powerful treatment options when MTX fails to induce remission within 3 months.
• Safety data suggest biologics are generally well-tolerated, with infections more often linked to comorbidities or concomitant therapies (corticosteroids, MTX) than biologics themselves.

Impact:

• Biologics offer improved outcomes for RA patients, allowing for more ambitious treatment goals like remission.
• Understanding the safety profile, including potential risks like cutaneous cancers, is crucial for optimizing biologic use and patient monitoring.
• Strategic selection and vigilant monitoring of biologic therapies are essential for maximizing benefits while minimizing risks in RA management.