Recent advances in the management of rheumatoid arthritis

A truly remarkable transformation in RA management has occurred over the past decade. Patient and physician expectation of treatment effect are now high, and management of inflammatory disease and co-morbidity is more readily tailored to individual patient needs.  Therapy in rheumatoid arthritis encompasses symptom-relieving  drugs  (mainly  NSAIDS)  and  DMARDS  that  retard  progression  of  the disease.  Increasingly, the aim of DMARD therapy is to achieve early and sustained suppression  of  disease  activity.    Where  this  can  be  achieved  NSAIDS  could potentially be discontinued. The rapid expansion of available therapies for RA over the  past  decade  is  exciting, but  necessitates  constant  re-evaluation  of  treatment goals and toxicity profiles.  It may be that the early use of DMARDS including anti-TNFα drugs will render NSAIDS and corticosteroids unnecessary.  Early, sustained and intensive treatment will hopefully improve medium and long-term outcomes in RA.  In this review we outline issues that have arisen with the use of NSAIDS and advances in the use of existing DMARDS.  In addition, currently available biological agents and those in development are also discussed.