RHEUMATOID ARTHRITIS: A NOVEL APPROACH IN DIAGNOSIS AND TREATMENT

Abstract

The rheumatoid arthritis is chronic disease with progressive course and deteriorations of joints as well as other organs. The pathogenesis of rheumatoid arthritis is characterized with chronic synovitis and inflammation. The main roles in development of rheumatoid arthritis have auto-reactive T cells and inflammatory cytokines, especially tumor necrosis factor a, interleukin 1 and interleukin 6. The management of rheumatoid arthritis has evolved significantly in the past twenty years, especially with introduction new diagnostic criteria by European League for Rheumatoid Arthritis which are very sensitive for early arthritis. The main goal of treating rheumatoid arthritis is to start with therapy in the phase of the disease when destruction of joints can still be prevented. Therapeutic strategies for rheumatoid arthritis in-volve wide palette of different drugs which can be divided into conventional and biological Disease Modifying Antirheumatic Drugs. The use of methotrexate in combination with biological drugs provide targeting not only structural changes in rheuma-toid arthritis but also and immunological pathways in development of rheumatoid arthritis. These drugs synergistically provide clinical remission and low activity of rheumatoid arthritis in the majority of patients. The uses of biological drugs are limited due their high costs or safety profile. In order to reduce costs and toxicity in the treatment of rheumatoid arthritis, new treat-to-target concept is established. The new class of drugs which modulate signal pathways and activity of tyrosine kinase are under investi-gations in post marketing surveys in patients with rheumatoid arthritis as in efficacy as in safety issues.