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ANGELO GAFFO, M.D., is Fellow; KENNETH G. SAAG, M.D., M.Sc., is Associate Professor of Medicine and Director of the Center for Education and Research and Therapeutics of Musculoskeletal Diseases; and JEFFREY R. CURTIS, M.D., M.P.H., is Assistant Professor of Medicine and Associate Director of the Center for Education and Research and Therapeutics of Musculoskeletal Diseases, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham.

Address correspondence to Dr. Curtis at the University of Alabama at Birmingham, 510 20th Street South, FOT 840, Birmingham, AL 35294 (jcurtis{at}uab.edu).

Purpose. Current and investigational treatments of rheumatoid arthritis (RA) are described. Summary. The current therapies used to treat RA include nonsteroidal antiinflammatory drugs (NSAIDs), used for the management of pain and inflammation; disease-modifying antirheumatic drugs (DMARDs), used as first-line therapy for all newly diagnosed cases of RA; and biological-response modifiers, targeted agents that selectively inhibit specific molecules of the immune system. Glucocorticoids and other antirheumatic drugs are also used to treat RA. DMARDs include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide. NSAIDs and glucocorticoids are effective in controlling the pain, inflammation, and stiffness related to RA. Unlike NSAIDs, they slow clinical and radiographic progression of RA. The biological-response modifiers include infliximab, etanercept, and adalimumab (inhibitors of tumor necrosis factor [TNF]-); anakinra, a recombinant inhibitor of interleukin-1; abatacept, the first costimulation blocker; and rituximab, a chimeric anti-CD20 monoclonal antibody. Investigational therapies for RA include anti-interleukin-6-receptor monoclonal antibodies, new TNF- inhibitors (including one for oral administration), and antibodies against proteins critical for B-cell function and survival. Data accumulated in the past decade favor early aggressive therapy for patients suspected of having RA, including early referral to a rheumatologist, new diagnostic techniques, and aggressive therapy with DMARDs, glucocorticoids, and biological agents. The benefits of this approach have been demonstrated in clinical trials. Conclusion. Pharmacologic treatments of RA include NSAIDs, glucocorticoids, DMARDs, and biological agents. With an improved understanding of the pathophysiology of RA and the evidence from various clinical trials with the agents, early aggressive therapy with a combination of drugs or biological agents may be warranted for the effective treatment of RA. Index terms: Abatacept; Adalimumab; Anakinra; Antibodies; Antiinflammatory agents; Arthritis; Chondroprotective agents; Diagnosis; Drugs, investigational; Etanercept; Hydroxychloroquine; Immunomodulating agents; Infliximab; Leflunomide; Methotrexate; Rituximab; Steroids, cortico-; Sulfasalazine

 

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