Over the past 20 years, the drugs available for treating RA have increased drastically, leading to revised pharmacotherapy strategies.
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Rheumatoid arthritis (RA) can be defined as a chronic autoimmune systemic inflammatory condition characterized by symmetrical polyarthritis. Typically, patients present with pain, stiffness and warmth of the affected joints. The condition can result in extra-articular features, adding to disability, and may eventually lead to premature death, especially if not treated early and appropriately.1,2 Over the past 20 years, the drugs available for treating RA have increased drastically, leading to revised pharmacotherapy strategies. As Bijlsma points out in an article published in 2010, the main changes in RA management were due to new drugs, namely biologics. In turn, these drugs led to improved treatment strategies and a joint European League Against Rheumatism (EULAR)–American College of Rheumatology (ACR) work group, which devised the “treat to target” concept.3-5 The biologic era led to the availability of biosimilars, which are affecting the pharmacoeconomic aspect of the financial expenses of many national health services.6-8
Revolutionized Treatment Strategies
Pharmacological therapy for RA aims to control not only the symptoms of inflammation characteristic of RA but, more importantly, disease progression and remission, if possible. In fact, this is the underlying stem of treat to target. The traditional pyramidal approach that was the mainstay treatment strategy until the late 1990s was based on initiating analgesics and anti-inflammatory agents as first-line drugs.9 If symptoms of RA remained uncontrolled or if there was radiological evidence of progression of the disease, disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, sulfasalazine, sodium aurothiomalate hydroxychloroquine, penicillamine and azathioprine, would be prescribed as second-line drugs. Combination therapies of DMARDs were used in case of continued disease progression and corticosteroids were considered third-line agents.10
