Current Therapeutic Options in the Treatment of Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation of the joints. Untreated RA leads to a destruction of joints through the erosion of cartilage and bone. The loss of physical function is the consequence. Early treatment is important to control disease activity and to prevent joint destruction. Nowadays, different classes of drugs with different modes of action are available to control the inflammation and to achieve remission. In this review, we want to discuss differences and similarities of these different drugs.

Keywords: DMARD; MTX; Rheumatoid Arthritis; Tumor Necrosis Factor-Alpha Inhibitors; therapy.

Figure 1

Algorithm adapted from the 2016 European League Against Rheumatism (EULAR) recommendationson rheumatoid arthritis (RA) management. bDMARD, biological; bsDMARD, biosimilar DMARDs; csDMARDs, conventional synthetic DMARDs; DMARDs disease modifying amtirheumatic drug; IL, Interleukin; MTX, methotrexate; TNF, tumor necrosis factor; tsDMARDs, targeted synthetic DMARDS.

Figure 2

Cytokines bind to the receptors, which then undergo a change in their configuration into a dimeric structure, thereby activating their ability to work as a kinase. Consequently, they phosphorylate the STAT molecules (Signal Transducer and Activator of Transcription). Phosphorylated STATs also form dimeres that travel to the cell core, where they activate transcription processes, which further fuel inflammatory processes.