Therapeutic Options In The Treatment Of Rheumatoid Arthritis

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RA is a chronic inflammatory disease of the joints that affects approximately 1% of the general population. It is characterized by swelling, stiffness, and pain in multiple joints, and particularly, symmetrical involvement of the small joints of the hands and feet. RA is a significant cause of disability, and the majority of patients experience progressive joint destruction, deformity, and functional decline over a 10- to 15-year period (1). The basic aim of RA management is to reduce pain, improve function, and prevent or retard long-term disease progression. The major groups of therapeutic agents used are summarized in Table 1. Symptomatic agents include simple analgesia and nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs reduce pain and may improve function but do not fundamentally alter the underlying course of the disease. The second major class of agents are the disease-modifying antirheumatic drugs (DMARDs). This group of drugs usually takes several weeks or months to realize their full effect. They not only cause reduction in pain and swelling but, more importantly, also retard the rate of joint erosion, thus modulating the disease course. Corticosteroids are also frequently

Table 1 Classification of Drugs Commonly Used in the Treatment of Rheumatoid Arthritis

Drug group Examples

Table 1 Classification of Drugs Commonly Used in the Treatment of Rheumatoid Arthritis

Drug group Examples

Simple analgesia

Paracetamol, codeine

NSAIDs

Ibuprofen, diclofenac, celecoxib, rofecoxib

Corticosteroids

Prednisolone, prednisone, deflazocort

DMARDs

MTX, sulfasalazine, gold, sodium

aurothiomalate, D-penicillamine,

hydroxychloroquine, AZA, leflunomide

Biologic drugsa

Anti-TNF-a drugs: infliximab, etanercept,

adalimumab; IL-1 receptor antagonists:

anakinra

aSome are classified as disease-controlling antirheumatic drugs (DCARTs).

Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; DMARDs, disease-modifying antirheumatic drugs; TNF-a, tumor necrosis factor-a; IL-1, interleukin-1; MTX, methotrexate; AZA, azathioprine.

aSome are classified as disease-controlling antirheumatic drugs (DCARTs).

Abbreviations: NSAIDs, nonsteroidal anti-inflammatory drugs; DMARDs, disease-modifying antirheumatic drugs; TNF-a, tumor necrosis factor-a; IL-1, interleukin-1; MTX, methotrexate; AZA, azathioprine.

used in the management of RA. These drugs are anti-inflammatory and are employed as symptomatic agents. There is evidence, however, to support a disease-modifying role for corticosteroids in RA (2,3). More recently, biologic agents have been introduced for the treatment of RA (4,5). These drugs are specifically designed to block key mediators of the RA inflammatory pathway (6). They have considerable potential to retard the disease process, and the term "disease-controlling antirheumatic therapy (DCART)" has been coined to reflect the fact that certain of these biologic agents may halt further joint destruction in a majority of patients.

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