Abstract
Due to ongoing developments of novel agents in the field of biological pharmacotherapy, there are now more arrows available in clinicians' quivers for the treatment of rheumatic conditions. As a consequence, however, clear treatment strategies have to be defined in order to guarantee a qualitatively high and individually stage-adapted, state-of-the-art regimen for affected patients. This review summarizes recent evidence regarding the rationale of using different biological therapies to treat rheumatoid arthritis, the most common inflammatory joint disorder after activated osteoarthritis, and draws an actual picture of a possible standardized therapeutic algorithm without claiming exclusive appropriateness.
Highlights
The cure of diseases or at least an abatement of symptoms are the core aims of therapeutic medicine, and we might soon witness the transition from today’s abatement to tomorrow’s cure with regard to the quality of disease remission in the field of rheumatic conditions, with rheumatoid arthritis (RA) as one of the most frequent entities
Only disease-modifying anti-rheumatic drugs (DMARDs) may significantly slow, stop or even reverse the damage arising from chronic inflammation in cartilage or bone, as shown in an in vitro study on human chondrocytes in alginate cultures [4], for example, as well as in clinical trials implementing radiographic follow-up of patients
DMARDs may slow radiographic progression, data illustrate that progression can continue despite clinical disease control or remission [5]
Summary
The cure of diseases or at least an abatement of symptoms are the core aims of therapeutic medicine, and we might soon witness the transition from today’s abatement to tomorrow’s cure with regard to the quality of disease remission in the field of rheumatic conditions, with rheumatoid arthritis (RA) as one of the most frequent entities. Administering TNF-blocking agents up to the maximum approved dose for RA may evoke a response within 2 to 4 weeks in some patients, but a significant amelioration of disease should be seen within 12 to 24 weeks, leading to a documentable improvement in clinical and laboratory parameters In this case, the treatment should be continued according to the physical and patientoriented measures. Tocilizumab Tocilizumab (TOZ) is a humanized monoclonal anti-IL-6 receptor antibody It is administered intravenously in monthly dosages of 4 or 8 mg/kg body weight and is approved for moderate to severe active RA in combination with MTX or as a monotherapy in incomplete responders to DMARDs or TNF-blocking agents, where it can reduce the signs and symptoms of disease [66,67]. ANR might represent a possible option in individual treatment plans, its clear value and position within a possible pharmacotherapeutic algorithm of RA require further evidence from clinical observations
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