Rheumatoid Arthritis: Many Management Strategies, No Cure

Rheumatoid arthritis (RA) is a chronic inflammatory syndrome characterized by synovitis, joint swelling, and debilitating pain that result from bone and cartilage erosion. Uncontrolled, severe RA leads to joint deformity, disability, and premature death. The etiology of RA is not completely understood, but it is known to involve interplay between environmental factors, susceptibility genes, epigenetic factors, and posttranslational modifications in genetically predisposed individuals. A positive family history is the strongest risk factor for RA, and genomewide association studies have identified over 100 susceptible loci associated with RA-most within the human leukocyte antigen region. The inflammatory course of RA involves innate and adaptive immune cells activated by exogenous factors and autologous antigens, such as antibodies to citrullinated proteins and rheumatoid factor. Mediators of the immune response, cytokines, such as tumor necrosis factor-alpha, play a key role in the progression of RA, and are the targets for biologic treatment of RA. While traditional treatment approaches have focused on disease-modifying antirheumatic drugs, biologic therapies are providing a more targeted approach to disease management in the long term. This article reviews current treatment guidelines for RA, with a focus on the role and relevance of traditional treatment options in the era of biologic therapeutics.