Abstract
The development of targeted biologic therapy for rheumatoid arthritis (RA) has revolutionized treatment of this chronic disease and provided clinicians with a diverse menu of options for improving disease control, limiting radiographic progression of joint damage, and enhancing physical function. However, many fundamental questions about the optimal treatment of RA remain unanswered. What is the best initial DMARD therapy for patients with recent onset RA? What is the most effective treatment strategy for reducing long term damage? When should partially effective therapy be changed? How can the risks of drug therapy be mitigated for the individual patient? It is also difficult to translate our knowledge about the efficacy and safety of different therapies to the individual patient. Without validated biomarkers of treatment response, decision-making lacks a probability framework for predicting efficacy and toxicity at a ‘personalized’ level. For this reason, treatment decisions are guided by clinical intuition in the ‘real world’ despite being solidly grounded in a body of scientific evidence.
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