Rheumatoid arthritis: still a chronic disease

Abstract

For many years, few treatment options were available for patients with rheumatoid arthritis, leading to extensive joint damage and increased mortality compared with control groups. Progress in treatment of this chronic disease started in 1980 with the widespread use of methotrexate early in the disease course, followed by the first biological treatment to target the cytokine tumour necrosis factor (TNF) in 2000. 1 Klareskog L Catrina AI Paget S Rheumatoid arthritis. Lancet. 2009; 373: 659-672 Summary Full Text Full Text PDF PubMed Scopus (721) Google Scholar Presently, four anti-TNF monoclonal antibodies and one soluble receptor, etanercept, are marketed. Etanercept is a hybrid molecule composed of the soluble form of the type-2 p75 TNF receptor, which is linked to the fragment crystallisable region of IgG. Inhibition of TNF function results from the binding of TNF to etanercept. As a protein, etanercept is given systemically by subcutaneous self-administered injections of 50 mg once weekly. Methotrexate as a small chemical molecule can be taken orally, subcutaneously, or by intramuscular injection every week. Maintenance, reduction, or withdrawal of etanercept after treatment with etanercept and methotrexate in patients with moderate rheumatoid arthritis (PRESERVE): a randomised controlled trialConventional or reduced doses of etanercept with methotrexate in patients with moderately active rheumatoid arthritis more effectively maintain low disease activity than does methotrexate alone after withdrawal of etanercept. Full-Text PDF