Pharmacologic treatment of rheumatoid arthritis

Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory disease that affects the joints. This chronic inflammatory condition causes joint destruction and functional disability, and reduces the quality of life of patients. Therefore, the aims of RA treatment are to control a patient's symptoms by decreasing the inflammation, to prevent joint damage, and to maintain the patient's quality of life while minimizing the progress of the disease. In recent years, the early initiation of disease-modifying anti-rheumatic drugs (DMARDs) has been emphasized because a window of opportunity is thought to exist in early RA, when the disease is more responsive to treatment. Recently, the treat-to-target strategy for RA treatment has also been suggested. This strategy involves setting a goal such as remission or low disease state, implementing strict monitoring, and switching the medication regimen promptly as needed. Currently, several DMARDs are available to manage RA. DMARDs form two major classes: synthetic chemical compounds (sDMARDs) and biological agents (bDMARDs), which target specific pro-inflammatory cytokines to prevent inflammation. This review summarizes the effectiveness and safety of the current DMARDs available for RA treatment. Tumor necrosis factor inhibitors, T cell costimulation inhibitor, an anti-B cell agent, and the interleukin 6 receptor-blocking monoclonal antibody are classified as bDMARDs. Tofacitinib, a new sDMARD specifically designed to target janus kinases, is also discussed in this article.