Management of rheumatoid arthritis: the 2012 perspective

Abstract

Management of rheumatoid arthritis (RA) has improved over the last 10 years. These changes have been monitored in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) observational cohort, and clinical remission has become a realistic goal. However, we should recognize that the ultimate goal of treatment is to improve long-term outcomes. These improvements have been achieved not only by new drugs, but also by the overall approach toward treating patients. Biologics in RA have been successful; however, safety concerns and pharmacoeconomical issues are still debated. Protein kinase inhibitors have been developed, and can be called "molecular-targeting antirheumatic drugs" (MTARDs), as opposed to "disease-modifying antirheumatic drugs." In comparison with biologics, oral MTARDs should be less expensive; however, their safety profile should be confirmed. Considering the limitations of randomized trials, it is encouraged to conduct studies based on daily practice. It is time to consider the application of the evidence generated from "our" patients to patients in daily practice, namely institute-based medicine as opposed to evidence-based medicine, of which "IORRA-based medicine" would be representative. Finally, there remains much for us rheumatologists to do for our patients, including patient-perspective approaches.

Reducing glucocorticoid dosage improves serum osteocalcin in patients with rheumatoid arthritis—results from the TOMORROW study

“…First, the baseline disease activity score of patients with RA was relatively low (mean DAS28-ESR, 3.47), and the usage rate of bDMARDs in this study was 50 %. This rate is higher than the general average use in the real world [27,28] because of our protocol. Second, the change in disease activity from baseline to 1 year was small, so influences on bone metabolic RA rheumatoid arthritis, OC serum osteocalcin, PSL prednisolone, DAS disease activity score, ESR erythrocyte sedimentation rate, Δ change from baseline to 1 year markers might have been underestimated.…”

Estimates of the prevalence of and current treatment practices for rheumatoid arthritis in Japan using reimbursement data from health insurance societies and the IORRA cohort (I)

“…Therefore, we conducted a study with the following aims: (1) to determine the current prevalence of RA in Japan and (2) to examine current treatment practices. To achieve these aims, we conducted analyses of reimbursement data covering *1 million people (0.84 % of the Japanese population) who were members of Japanese health insurance societies.…”

Refrakter Romatoid Artrit Tedavisinde Terapotik Aferez Uygulamaları

“…Hidroksiklorokin, sülfasalazin, methotreksat, leflunomid ve daha az kullanılan, siklosporon, altın tuzları, D-penisilamin ile son 10 yıldır tedaviye giren biyolojik ajanlar olarak bilinen başta TNF (tumor necrosis factor) alfa inhibitörleri (etanercept, infliksimab, adalimumab, certolizumab, golimumab) ve interlökin-6 antagonistleri (İL-6) ve anti-CD20 antagonisti (ritüksimab) hastalığı modifiye edici ajanlar arasında sayılabilir. B hücre aktive edici faktör (BAFF), yüzey T hücreleri ya da B hücre molekülleri, CD86, CD20, CD22 dahil olmak üzere İL-17 ve İL-12/23 gibi proinflamatuar sitokinleri hedefleyen RA tedavisin de birçok aday moleküller vardır 6 .…”