Therapeutic strategies for rheumatoid arthritis.

It affects approximately 0.8 percent of adults worldwide, 2 is more common in women (by a ratio of 3 to 1), and has an earlier onset in women, frequently beginning in the childbearing years. 3 Recent advances in understanding the cytokine networks that are responsible for the ongoing inflammatory response in rheumatoid arthritis 4 have led to the successful use of therapies that target tumor necrosis factor a (TNFa ) and interleukin-1. 5 (These therapies were discussed in a recent review in the Journal . 6 ) During the past 10 years, improved understanding of the pathophysiology of rheumatoid arthritis has led to several key changes in the approach to therapy. First, early diagnosis and treatment are important. Second, the use of disease-modifying antirheumatic drugs (DMARDs) in combination is highly effective. Third, the use of agents that target cytokines, such as TNFa and interleukin-1, is an effective strategy. And fourth, recognition is growing that the assessment of treatment outcomes should include an analysis of important coexisting illnesses (particularly cardiovascular disease and osteoporosis). In this article, I will discuss the clinical application of these principles, which has resulted in a marked improvement in clinical outcomes. 7,8