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KMID : 0604720030100020218
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Journal of Rheumatology Health
2003 Volume.10 No. 2 p.218 ~ p.219
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Advances In Treatment For Rheumatoid Arthritis
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J Moots, Robert
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Abstract
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Rheumatoid arthritis (RA) is the most common autoimmune disease and causes considerable morbidity and a reduced life expectancy. Sadly, therapy for RA in the past has been inadequate-with ineffective drugs used, or effective drugs withheld until joint damage and disability had already occurred. Over recent years, however, the treatment of RA has advanced significantly and this is set to continue, even more dramatically, in the future. The first major advance was the appreciation that early and aggressive treatment with conventional disease modifying anti-rheumatic drugs, typified by methotrexate, can significantly suppress disease activity and improve outcome. The second major development, the biologic drugs, resulted from breakthroughs in understanding the pathological mechanisms that underlie RA, heralding an exciting new era of therapy.
Many pathological processes are involved in the inflammation of RA. These range from cellular mechanisms, typified by the T-lymphocyte, through to cytokines-of which TNF-(and IL-Vappear to be the most important. Targeting T cells for therapy was theoretically attractive, but has yet to fulfil its promise in the clinic. Anti-cytokine drugs, typified by the anti-TNF-(agents (the soluble receptor, etanercept and monoclonal antibodies, infliximab and adalimumab) have, in contrast, proven to be highly effective in RA and provide fresh hope for patients with previously refractory disease. Pivotal trials have confirmed the efficacy of anti-TNF-(therapy in RA and this is borne out by clinical experience. However, these drugs differ in adverse effect profile (infliximab is associated with reactivation of tuberculosis and other infections). in disease indication (infliximab is effective in Crohn´s disease and etanercept is not) and potentially in efficacy in RA (with open label studies and meta-analyses favouring etanercept). In addition, these drugs provide new and powerful tools to investigate the pathophysiological
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KEYWORD
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