Rheumatoid arthritis

Rheumatoid arthritis is a systemic inflammatory disorder that mainly affect s the diarthrodial joint. It is the most common form of inflammatory arthri tis, and has a substantial societal effect in terms of cost, disability, an d lost productivity. Although the pathogenesis of rheumatoid arthritis rema ins incompletely understood, much insight into the cellular and molecular m echanisms involved has been gained in the past decade. On the basis of thes e insights, new therapies have been developed, and clinical trials have sho wn the efficacy of aggressive treatment of patients with active disease. In this review, we discuss improvements in our understanding of the pathophys iology of inflammatory synovitis in rheumatoid arthritis, and improvements in therapy for patients with the disorder. The past decade has seen substan tial advances in these areas. Future studies will be directed at improving methods for early diagnosis and identification of patients with progressive disease, and at Improving methods to Identify candidates for subclasses of disease-modifying antirheumatic drugs (DMARDs). Long-term safety and effic acy data for the new DMARD agents and combination regimens will also furthe r delineate efficacy and toxicity and thus the appropriate clinical context for use of these therapeutic approaches. The continuing elucidation of pat hophysiological pathways relevant in rheumatoid arthritis, coupled with con tinuing advances In biotechnology and rational drug design, offer substanti al hope for the continued development of increasingly potent and specific p harmacotherapy for treatment of rheumatoid arthritis.