title: Understanding emerging treatment paradigms in rheumatoid arthritis.
abstract: Treatment strategies for rheumatoid arthritis (RA) will continue to evolve as new drugs are developed, as new data become available, and as our potential to achieve greater and more consistent outcomes becomes more routine. Many patients will find both symptom relief and modest control of their disease with disease-modifying antirheumatic drugs (DMARDs), yet this course of therapy is clearly not effective in all patients. In fact, despite strong evidence that intensive treatment in the early stages of RA can slow or stop disease progression and may prevent disability, many patients continue to be managed in a stepwise manner and are treated with an ongoing monotherapy regimen with DMARDs. There is now a large body of evidence demonstrating the success of treating RA patients with anti-TNF therapy, usually in combination with methotrexate. As a result of the increased use of anti-TNF therapy, treatment paradigms have changed - and our practice is beginning to reflect this change. In the present review, we summarize the salient points of several recently proposed and emerging treatment paradigms with an emphasis on how these strategies may impact future practice.
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, C1-39, PO Box 9600, 2300 RC Leiden, The Netherlands. F.C.Breedveld@lumc.nl
authors.forename: Ferdinand C
authors.initials: FC
authors.lastname: Breedveld
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D001688:Biological Products / Q000627:therapeutic use; D002981:Clindamycin; D002986:Clinical Trials as Topic; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D000069285:Infliximab; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use; D012074:Remission Induction; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha; D002981:Clindamycin; D000069285:Infliximab; D008727:Methotrexate