Rheumatoid arthritis in 2003: where are we now with treatment?

The treatment of rheumatoid arthritis (RA) has changed considerably over the course of the century. It is difficult to fathom that 100 years ago it was directed towards removing potential sources of infection, with dental extractions and tonsillectomies. Despite appreciable advances, many of the tenets that we currently hold for the management of RA were originally proposed over 70 years ago. Russell Cecil in his Textbook of medicine published in 1931 advocated early treatment of RA “ . . . perhaps the most important factor in prognosis is the application of rational therapy early in the disease.” In 2003, we advocate early intervention with disease modifying treatment. Many of the treatments we use today have been developed over 50 years, including gold salts, sulfasalazine, and corticosteroids. In 2003, methotrexate treatment, early institution of disease modifying antirheumatic drugs (DMARDs), combination DMARDs, and the tumour necrosis factor (TNF)α inhibitors generate the greatest amount of interest for the treatment of RA.