State of the Art in Novel Treatment Strategies in Rheumatoid Arthritis: A Brief Review

Abstract

Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease with substantial morbidity and socioeconomic burden. Early diagnosis and treatment are crucial to mitigate disease progression and preserve joint function. Current treatment strategies encompass non-pharmacological and pharmacological approaches, with disease-modifying antirheumatic drugs (DMARDs) being the cornerstone of pharmacotherapy. Novel immunomodulating drugs have revolutionised RA management by targeting specific cytokines or intracellular signalling pathways involved in disease pathogenesis. Evidence-based guidelines recommend biologics as second-line therapy for patients for whom conventional DMARDs have failed. While Tumour Necrosis Factor Inhibitors (TNFi) have traditionally been favoured, recent evidence suggests nuanced responses based on patient characteristics and treatment history are more effective. Moreover, Janus Kinase (JAK) Inhibitors emerge as a promising therapeutic option, demonstrating comparable efficacy to bDMARDs in clinical practice. Despite significant advancements, challenges in optimising RA treatment include variable treatment responses and safety concerns. Future research aims to refine treatment strategies, personalise therapeutic approaches, and elucidate disease mechanisms to improve outcomes for RA patients. The evolving landscape of immunomodulating drugs offers diverse therapeutic options for RA management. This article provides a comprehensive review of RA therapy, focusing on novel immunomodulating drugs.

Keywords: immunobiological; rheumatoid arthritis; treatment.

Figure 1.

Comparative flowchart of the main treatment guidelines for rheumatoid arthritis (EULAR, ACR, and BSR). ACR: American College of Rheumatology; EULAR: European League Against Rheumatism; BSR: Brazilian Society of Rheumatology.