Treatment options for rheumatoid arthritis

Over the last several decades, approaches to the management of rheumatoid a rthritis (RA) have been empirical. Subsets of RA patients respond well to t raditional disease-modifying antirheumatic drugs (DMARDs), either as single therapy or in combination. However, a significant population remains untre ated or undertreated. The lessons learned from DMARD strategies have led to stratification of patients based on observed or expected disease progressi on. At the same time, clinicians have gained a better understanding of the immunology and immunopathophysiology of RA. The advent of monoclonal antibo dy technology and other advances in biotechnology have resulted in the deve lopment of agents that target specific components of the immune response. R ecent trials with 2 antitumor necrosis factor alpha (TNF alpha) chimeric an tibody agents, etanercept and infliximab, have shown promising results, bot h as proof of concept and in more rigorous clinical trial populations leg, patients who are refractory to (DMARDs). Future directions include combinat ion DMARD/biologic agent therapy, and other molecular strategies targeted t o parts of the immune response that appear to be dysregulated in RA patient s. Stratifying patients will hopefully lead to more tailored and targeted t herapies and a more cost-effective approach to RA management.