[Indication for a modern therapy of rheumatoid arthritis]

The treatment of rheumatoid arthritis is currently based on pathogenesis and pathophysiology, being the etiology still unknown. At cognition and activation phase of rheumatoid arthritis, there is a number of potential therapeutic approaches, still in development and in early trials. At inflammation and even more at invasive phase of rheumatoid arthritis, the treatment should take into consideration the parallel activation of several different processes, sustained by the heterogeneity of cells in the inflamed synovium. The early detection of potential severe rheumatoid arthritis patients is crucial, in order to be able to adjust the treatment according to the severity of disease in each patient. Evaluation of genetic and clinical markers for severe disease within the sixth month and in any case no later than the third year of disease is recommended. As far as pharmacotherapy is concerned, it is useful to distinguish anti-rheumatic agents in symptom-modifying drugs (SM-ARDs) and disease-controlling therapy (DC-ART). Discovering the causal agent of rheumatoid arthritis could dramatically change the treatment of rheumatoid arthritis. In the meantime, one can envisage a further development of immuno-pharmacotherapy and the introduction in the clinical practice of specific or selective immunotherapy.