Rheumatoid Arthritis: Advances in Understanding and Treatment

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Rheumatoid arthritis and osteoarthritis are the two major joint diseases afflicting mankind. Rheumatoid arthritis is considered an inflammatory disease, now understood to involve the immune system in its pathogenesis. Osteoarthritis is not considered an inflammatory disease, but rather a degenerative joint disease that might be punctuated with bouts of inflammation, particularly in advanced stages of the disease. This report describes recent advances in the understanding and treatment of rheumatoid arthritis.

Current therapy is limited to non-steroidal antiinflamm-atory drugs (NSAIDs), corticosteroids and a variety of disease-modifying antirheumatic drugs (DMARDs). There are currently several classes of DMARDs available to the clinician, including several immunosuppressants that have recently been approved for rheumatoid arthritis. However, there is general dissatisfaction with these drugs for two major reasons: (1) incidence of adverse events, particularly with the more potent DMARDs, and (2) inability to reverse disease progression. Current therapy can effectively delay disease progression, relieve pain and improve the quality of life, but no drugs have demonstrated the ability to reverse joint destruction.

The impetus for the development of novel approaches for the treatment of rheumatoid arthritis is therefore strong. New ways to use existing drugs are being tested in the clinic, and many new drugs representing entirely new drug classes are undergoing preclinical and clinical evaluation. This report summarizes advances in the development of immunosuppressants, NSAIDs, corticosteroids, matrix metalloproteinase and other proteinase inhibitors, modulators of cytokine function, signal transduction inhibitors, complement inhibitors, and other miscellaneous drugs.

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