Rheumatoid arthritis

Abstract

Rheumatoid arthritis is an autoimmune inflammatory disease primarily characterized by synovitis which is accompanied by extra-articular organ involvement, such as interstitial pneumonia, in addition to clinical symptoms including pain, swelling, stiffness of multiple joints, fever, and malaise. Joint destruction progresses soon after the onset, and once the affected joints are deformed, the development of irreversible physical dysfunction is noted. Thus, proper diagnosis and treatment are required from the early stages of the disease. Although palliative therapy with glucocorticoids and anti-inflammatory drugs had been used, disease-modifying antirheumatic drugs (DMARDs) are currently used to suppress immune abnormalities and to control disease activity. DMARDs are classified into different groups, such as conventional synthetic DMARD, targeted synthetic DMARD, and biologic DMARD. The appropriate use of these drugs has allowed remission to be the therapeutic goal in all patients. By maintaining remission, these drugs have also been shown to prevent the progression of joint destruction and physical dysfunction over a long period. The advent of molecular-targeted therapies has allowed for the use of treatments based on pathological mechanisms, and such therapeutic strategies have also been applied to the treatment of various autoimmune inflammatory diseases. In the future, safer and more effective treatments, therapeutic strategies aimed at drug holidays or cure, and the introduction of precision medicine are expected.

Keywords: Biological; DMARD; Diagnosis; Rheumatoid arthritis; Treatment.

Fig. 1

The rheumatoid arthritis classification criteria published by the ACR/EULAR in 2010. Modified from reference [6]

Fig. 2

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological DMARDs: 2019 update. Modified from reference [8]

Fig. 3

Strategies for the treatment of rheumatoid arthritis. Intensive treatment is required for inducing remission in rheumatoid arthritis, but subsequently maintaining remission with high adherence and safety is a prerequisite for the good long-term outcome. The de-escalation and drug holiday of the DMARDs is an extension of the maintained remission