title: Management of rheumatoid arthritis: the 2012 perspective.
abstract: Management of rheumatoid arthritis (RA) has improved over the last 10 years. These changes have been monitored in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) observational cohort, and clinical remission has become a realistic goal. However, we should recognize that the ultimate goal of treatment is to improve long-term outcomes. These improvements have been achieved not only by new drugs, but also by the overall approach toward treating patients. Biologics in RA have been successful; however, safety concerns and pharmacoeconomical issues are still debated. Protein kinase inhibitors have been developed, and can be called "molecular-targeting antirheumatic drugs" (MTARDs), as opposed to "disease-modifying antirheumatic drugs." In comparison with biologics, oral MTARDs should be less expensive; however, their safety profile should be confirmed. Considering the limitations of randomized trials, it is encouraged to conduct studies based on daily practice. It is time to consider the application of the evidence generated from "our" patients to patients in daily practice, namely institute-based medicine as opposed to evidence-based medicine, of which "IORRA-based medicine" would be representative. Finally, there remains much for us rheumatologists to do for our patients, including patient-perspective approaches.
authors: Institute of Rheumatology, Tokyo Women's Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan. amanaka@ior.twmu.ac.jp
authors: Hisashi
authors: H
authors: Yamanaka
authors: Yohei
authors: Y
authors: Seto
authors: Eiichi
authors: E
authors: Tanaka
authors: Takefumi
authors: T
authors: Furuya
authors: Ayako
authors: A
authors: Nakajima
authors: Katsunori
authors: K
authors: Ikari
authors: Atsuo
authors: A
authors: Taniguchi
authors: Shigeki
authors: S
authors: Momohara
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D015331:Cohort Studies; D019317:Evidence-Based Medicine; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D058990:Molecular Targeted Therapy; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011364:Professional Practice; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D012074:Remission Induction; D012219:Rheumatology / Q000191:economics / Q000379:methods* / Q000639:trends
chemical_list: D018501:Antirheumatic Agents; D007166:Immunosuppressive Agents; D047428:Protein Kinase Inhibitors