Drug therapy of inflammatory arthritis

Abstract

Inflammatory arthritis involves a diverse range of conditions in which an uncontrolled immune response occurs. A number of advances in assessment, diagnosis and treatment have been made in recent years. Drug therapies used in inflammatory arthritis aim to reduce symptoms and suppress inflammation, joint damage and disability. In rheumatoid arthritis (RA), immunosuppression is used in almost all patients, with an emphasis on early aggressive treatment to achieve clinical remission. This approach is less successful in spondylarthropathies, for which non-steroidal anti-inflammatory drugs remain first-line therapy. The use of biologic therapies has increased dramatically across a range of indications and has resulted in improved outcomes for patients. These agents are associated with an increased risk of infection, particularly tuberculosis in patients receiving tumour necrosis factor inhibitors. Alternative biologics have entered clinical practice for RA in recent years, and clinical trials using these agents, as well as novel non-biologic therapies, are in progress for RA and other conditions.

Fig 1.

Treating to target in rheumatoid arthritis (RA). A defined treatment aim should be selected: preferably clinical remission, or low disease activity in patients with long-term disease. Patients with active disease should be reviewed frequently and disease activity should be assessed using a composite disease activity score. Therapy should be escalated if disease remains active. DMARD, disease-modifying antirheumatic drug. Adapted from Smolen et al.