Cytokine blockade as a new strategy to treat rheumatoid arthritis - Inhibition of tumor necrosis factor

Rheumatoid arthritis (RA) is a common, frequently severe, chronic inflammat ory disease. Although the cause of RA remains unknown, recent advances in u nderstanding its pathogenesis have been substantial. Despite the use of a v ariety of medications, particularly methotrexate, treatment of RA is not fu lly effective in most patients. Until recently, insights into inflammatory mechanisms in RA had not been successfully translated into novel classes of therapeutic agents. This gap now will likely be bridged in the form of a n ew strategy for treating RA-cytokine blockade. Although a variety of cytoki nes are important in the pathogenesis of RA, tumor necrosis factor (TNF) se ems to play a pivotal role. Neutralizing TNF in patients with RA, by means of soluble TNF receptors or anti-TNF monoclonal antibodies, has proven to b e a powerful means of controlling disease activity. Studies are in progress to obtain additional information regarding long-term safety of TNF blockad e and its effects on disease progression.