Management of refractory rheumatoid arthritis

Based on the results of a MEDLINE search (1992-1997), the term 'refractory rheumatoid arthritis' (refractory RA) is ill-defined, in terms of both pati ent characterization and description of previous treatments. Current strate gies of management of refractory RA include increasing disease-modifying an ti-rheumatic drug dosage above standard dosage regimens, using combination therapy, and adding or increasing the dosage of corticosteroids. Options fo r further strategies include target-oriented biological agents (e.g. anti-t umour necrosis factor), gene therapy, stem-cell treatment and oral toleranc e induction.