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The paradigm for the management of rheumatoid arthritis (RA) has shifted in the past two decades. The appreciation of increased mortality in patients with RA and the poor outcomes with conventional therapy led to the concept of the early aggressive treatment to suppress ongoing inflammation and prevent joint injury. RA results from acute and chronic inflammation in the synovium associated with proliferative and destructive processes in the joint. Affected areas may either heal without structural defects, or be irreversibly damaged if inflammation is severe and does not remit. Therefore, measures aimed at identifying early active disease and ameliorating inflammation are essential and may be highly effective in modifying disease outcome. The goal of treatment is to achieve and maintain a state of remission or, at the least, a state of low disease activity, in order to prevent joint damage and disability. This requires the initiation of treatment early in the disease process, as well as vigilant monitoring throughout the course of disease, with prompt readjustment of therapy, for flares of activity and for medication toxicity. This aggressive approach has been made possible by the increasing number of effective non-biologic and biologic disease-modifying anti-rheumatic drugs (DMARDs). Recent trends and guidelines for the management of RA are presented here. (Korean J Med 76:18-24, 2009) |
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