Treating rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory disease affecting the synovial joints. It is characterised by persistent inflammation and destruction of bone and joints. It affects physical functioning and other dimensions of quality of life. Symptoms can be treated with analgesics and non-steroidal anti-inflammatory drugs, which block cyclo-oxygenase. The underlying disease process can be affected by drugs that block or reduce the concentration of cytokines, which are known as disease modifying antirheumatic drugs. These drugs are either conventional small molecules or biological molecules.

The outcome of treatment for patients with rheumatoid arthritis has improved considerably during the past 20 years.1 People have speculated about the potential to reverse the disease for some time. Treatments that aim to induce remission have been called for since the start of the 1990s.2 Several approaches have been investigated, including step-up (adding one drug to another) and step-down (starting with a combination of drugs and withdrawing individual ones) regimens3 and giving three disease modifying antirheumatic drugs at the same time.4 All approaches have reduced inflammatory activity, delayed radiographic progression, and improved function and quality of life. However, only a few patients have achieved remission.5

The benefits of …