title: [Therapeutic update in rheumatoid arthritis].
abstract: The treatment of rheumatoid arthritis (RA) was revolutionized by the introduction of the biologics. Their power and their good safety profile have allowed to define new objectives and procedures to reach them; it is the "treat to target" concept. New recommendations were published by EULAR or ACR to obtain the remission as soon as possible. Disease-modifying antirheumatic drugs, in particular the methotrexate (MTX), remain the cornerstone of RA treatment in association with symptomatic treatments. The use of corticosteroids can be necessary to control the disease activity in the waiting time of the DMARDs efficiency or to control a flare. The absence of remission after 3months after initiation of MTX should prompt the rheumatologist to intensify the treatment with biologics. The increasing number of biologics targeting different mechanisms (5 anti-tumor necrosis factor-α, antagonist of interleukine-1 [IL-1] receptor, antagonist of IL-6 receptor, anti-CD20, anti-cytotoxic T-lymphocyte antigen 4) asks the question of the strategy in their prescription. Besides, all the registers or meta-analysis plead in favor of a good safety subject to a moderate prescription and to a greater vigilance. Except the opportunist infections, it is more the comorbidities or the associated treatments such as corticoids or MTX, which would favor the infections than anti-TNFα. There is no indication that biologics may increase the risk of solid cancer compared with a population of RA patients not exposed to anti-TNFα. However, biologics could increase the risk of cutaneous cancers, including melanoma.
authors.affiliation: Inserm 905, institut de recherche et d'innovation biomédicales, service de rhumatologie, Pavillon la Colombière, hôpital de Bois-Guillaume, hôpitaux de Rouen, université de Rouen, CHU de Rouen, 76031 Rouen cedex, France. Electronic address: thierry.lequerre@chu-rouen.fr.
authors.forename: T
authors.initials: T
authors.lastname: Lequerré
authors.forename: G
authors.initials: G
authors.lastname: Avenel
authors.forename: O
authors.initials: O
authors.lastname: Vittecoq
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000628:therapy*; D001688:Biological Products / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D006801:Humans; D012074:Remission Induction; D013810:Therapeutic Equivalency; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D001688:Biological Products
keywords: Anti-TNFα; Biologics; Biomédicaments; Polyarthrite rhumatoïde; Remission; Rheumatoid arthritis; Rémission; Safety profile; Tolérance