REVIEW - Recent advances in RA

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Postgrad Med J. 2010 Apr;86(1014):243-50.

Recent advances in rheumatoid arthritis

Suresh E.

Rheumatology Department, Kettering General Hospital, Rothwell Road,

Kettering NN16 8UZ, UK.

Abstract

Management of rheumatoid arthritis (RA) has radically changed over the

last decade.

Diagnostic methods have improved with availability of highly specific

tests such as antibody to cyclic citrullinated peptide (specificity

approximately 96%), and introduction of advanced imaging modalities

such as ultrasound and magnetic resonance imaging to facilitate

earlier diagnosis.

The current aim of management is to achieve remission and prevent

joint damage. In order to achieve this goal, inflammation is

suppressed as much as possible during the early phase of the disease

before onset of joint damage. Aggressive treatments with combinations

of disease modifying anti-rheumatic drugs are commenced earlier in the

course of disease, and tight control maintained with regular objective

monitoring of disease activity.

Early use of anti-TNFalpha (tumour necrosis factor alpha) therapy in

combination with methotrexate helps to achieve better clinical and

radiographic outcomes, which can be maintained for up to 5 years after

withdrawal of anti-TNFalpha therapy.

Apart from anti-TNFalpha, several other biological treatments are now

available, including those that target CD20 on B cells (rituximab),

cytokines such as IL1 (anakinra) and IL6 (tocilizumab), and molecules

that cause interaction between antigen presenting cells and T cells

(abatacept).

There is better awareness and understanding of RA associated

complications such as cardiovascular disease and osteoporosis. Use of

non-steroidal anti-inflammatory drugs is on the decline in light of

recent concerns about cardiovascular safety.

Evidence is emerging in support of statins and bisphosphonates for

improving RA disease activity and preventing erosions, respectively.

In the coming years, further improvements in therapeutic strategies

are likely with the pace at which research is currently progressing.

PMID: 20354048

http://www.ncbi.nlm.nih.gov/pubmed/20354048

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