Rheumatoid arthritis: new trends in therapy

Recently, definite progress has been made in the pharmacotherapy of rheumatoid arthritis (RA). Since progression of joint damage is greatest during the first years of the disease, aggressive treatment nowadays is usually started early. RA has been considered to be a T cell driven disease, but therapies directed at eliminating T cells have not been consistently successful. Recent data indicate that macrophages may play an important role in the pathogenesis, and disease suppression has been demonstrated by antibodies against macrophage-derived cytokines. An important development in the treatment of RA has been the introduction of sulphasalazine and methotrexate, which are probably more effective than gold, D-penicillamine or hydroxychloroquine. The drug survival curve of the former drugs is better than that of the latter and their faster mode of action means that titration of these drugs towards optimal efficacy is easier. Due to these developments, the establishment of relevant measures for monitoring joint destruction and inflammatory mass are mandatory.