[New strategies for treatment of rheumatoid arthritis]

Rheumatoid arthritis(RA) is a chronic systemic inflammatory disease of unknown etiology, characterized by synovial inflammation and local tissue destruction. For many years, the traditional approach for the therapy of RA was the therapeutic pyramid. Recently, the beneficial effects of the pyramid strategy have been questioned because the long-term outcome of RA continues to be disappointing. Three developments stimulated a change in thinking: first, the increasingly precise understanding of pathogenesis, second, the availability of biological agents and, third, the methods of evaluation for RA therapy. Therefore, many treatment strategies for RA, almost of which prefer the earlier introduction of disease-modifying antirheumatic drugs, have been proposed. Several representative strategies are reviewed in this paper.