Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Deprecated: Implicit conversion from float 217.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534
Warning: imagejpeg(C:\Inetpub\vhosts\kidney.de\httpdocs\phplern\26932398
.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Korean+J+Intern+Med
2016 ; 31
(2
): 210-8
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Current concepts in the management of rheumatoid arthritis
#MMPMID26932398
Tanaka Y
Korean J Intern Med
2016[Mar]; 31
(2
): 210-8
PMID26932398
show ga
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by
inflammation and joint destruction that causes significant morbidity and
mortality. However, the combined use of methotrexate, a synthetic
disease-modifying antirheumatic drug (DMARD), and biologic DMARD has
revolutionized treatment of RA. Clinical remission is now realistic targets,
achieved by a large proportion of RA patients, and rapid and appropriate
induction of remission by intensive treatment with biological DMARD and
methotrexate is prerequisite to halt joint damage and functional disabilities.
However, biological DMARD is limited to intravenous or subcutaneous uses and
orally available small but strong molecules have been developed. Oral
administration of tofacitinib targeting the Janus kinase (JAK) is significantly
effective than placebo in active patients with methotrexatenaïve, inadequately
responsive to methotrexate or tumor necrosis factor (TNF)-inhibitors. The
efficacy was rapid and as strong as adalimumab, a TNF-inhibitor. Meanwhile,
association of tofacitinib on carcinogenicity and malignancy is under debate and
further investigation on post-marketing survey would be warranted. On the other
hand, discontinuation of a biological DMARD without disease flare is our next
goal and desirable from the standpoint of risk reduction and cost effectiveness,
especially for patients with clinical remission. Recent reports indicate that
more than half of early RA patients could discontinue TNF-targeted biological
DMARD without clinical flare and functional impairment after obtaining clinical
remission. Contrarily, for established RA, fewer patients sustained remission
after the discontinuation of biological DMARD and "deep remission" at the
discontinuation was a key factor to keep the treatment holiday of biological
DMARD.
free
free
free
