Management of the patient with severe refractory rheumatoid arthritis: are the newer treatment options worth considering?
Rheumatoid arthritis (RA) is a chronic, inflammatory, autoimmune disease leading to joint destruction. It is the most common cause of potentially treatable disabilities. The outcome of the disease varies from very mild to a refractory, rapidly progressive type with a high mortality rate. In recent years, profound changes in the traditional paradigms of RA therapy have been introduced. Instead of a therapeutically progressive approach, aggressive therapy is recommended for aggressive forms of RA. It has forced us to remodel the traditional treatment pyramid, and to start new strategies such as saw-tooth or step-down-bridge schedules. The last 10 years have seen wide acceptance of immunosuppressive therapy. These agents hold much promise for the further treatment of RA. A few years ago it seemed that we would be unable to influence the long term outcome in RA, but today the development of new drugs and techniques has increased our chances of fighting RA, and prospects for the future are even more promising.
Lacki
J K
JK
Department of Rheumatology and Clinical Immunology, Karol Marcinkowski University, School of Medical Sciences, Poznan, Poland. lacki@post.pl