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Treatment of rheumatoid arthritis: state of the art 2009

Nature Reviews Rheumatology volume 5, pages 531–541 (2009)Cite this article

Abstract

Few, if any, areas of medical therapeutics have witnessed such dramatic changes as those that have occurred in the therapy of rheumatoid arthritis (RA) during the past two decades. Improvements in clinical trials methodologies, the introduction of no fewer than nine biologic agents with distinct mechanisms of action, and the development of better strategies for the use of such agents have all contributed to the new age in RA therapeutics. Here, we review these developments and attempt to describe the current landscape of RA therapy in terms of available treatments, agreed-upon principles of RA management, as well as some important controversies in this field. Despite the great pace at which developments are moving, a treatment-free remission for patients with RA remains an elusive goal and unmet medical needs remain. The quest for better therapies for this potentially devastating disease is still as important as ever; research in this exciting area is ongoing, and it is reasonable to hope that, during the next decade, developments will lead to improved, rationally designed, targeted therapies for RA.

Key Points

  • Rheumatoid arthritis (RA) therapy has changed dramatically over the past 20 years

  • The early use of DMARDs, the use of DMARD combinations, and the use of biologic agents in patients who fail to respond to DMARDs are all part of the modern approach to treating RA

  • Strategies involving the use of low-dose glucocorticoids, as well as more-aggressive glucocorticoid regimens, have been effective

  • Despite these successes, there remains a considerable unmet need in RA therapy

  • Many new therapies and strategies are currently being investigated, raising hopes for an even better future for patients with this disease

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Figure 1: A schematic showing the simplified pathophysiologic pathways in rheumatoid arthritis and their main clinical consequences.
Figure 2: A schematic showing the simplified pathophysiologic pathways in rheumatoid arthritis, and where these processes can be interfered with by currently available biologic agents.
Figure 3: A schematic showing the simplified pathophysiologic pathways in rheumatoid arthritis and indicating where some of the new approaches currently being investigated might interfere with these processes.

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Acknowledgements

D. Lie, University of California, irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Department of Medicine, Rheumatology Unit, The Karolinska Institute, Stockholm, Sweden

    Ronald F. van Vollenhoven

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van Vollenhoven, R. Treatment of rheumatoid arthritis: state of the art 2009. Nat Rev Rheumatol 5, 531–541 (2009). https://doi.org/10.1038/nrrheum.2009.182

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