Rheumatoid Arthritis Treatment. A Back to the Drawing Board Project or High Expectations for Low Unmet Needs?

Abstract

Despite the significant progress in Rheumatoid Arthritis (RA) therapeutics, there are several reports in the literature claiming that the size of unmet needs in RA is large. In the era before biologics, there was indeed a significant number of patients who did not achieve low disease activity (LDA) or disease remission due to limited therapeutic choices in the doctors’ armamentarium. Treatment wise, great progress has been achieved over the last decades with the discovery and introduction in therapeutics of new molecules, such as the biological (b) disease-modifying anti-rheumatic drugs (DMARDs), and the targeted synthetic (ts) DMARDs. Today, with such a plethora of conventional synthetic (cs) DMARDs, tsDMARDs, and bDMARDs, why are we unable to successfully treat RA patients? What is wrong? However, a new drug for RA does not mean it is necessary to switch to a new treatment. It is very easy to change and switch therapies when the patient complains about pain and stiffness. In this setting, it is obligatory to rule out other comorbidities and disorders that may be the cause of the pain first. Thus, clinicians must have a deep knowledge of the drug therapy and be able to adjust the treatment when needed. A minute clinical examination must be carried out on every visit with close monitoring of the patient. A treat-to-target (T2T) approach and the application of the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) recommendations and strategies should minimize the unmet needs.

Effectiveness, Tolerability, and Safety of Tofacitinib in Rheumatoid Arthritis: A Retrospective Analysis of Real-World Data from the St. Gallen and Aarau Cohorts

“…It may result in functional impairment, declining health status and reduced quality of life for affected patients [1,2,3]. The principal goal in the treatment of RA is to achieve and maintain remission, or, if that is not attainable, low disease activity (LDA) [4,5].…”

<p>Clinical evaluation of the safety, efficacy and tolerability of sarilumab in the treatment of moderate to severe rheumatoid arthritis</p>

“…Although MTX is considered the cornerstone in the treatment of RA, it is ineffective or intolerable in up to 50% of patients 9. Furthermore, tumour necrosis factor (TNF) inhibitors, which are regarded as the standard of care for those patients, have not been proved a panacea, creating a therapeutic gap 10,11. In this direction, the inhibition of other cytokines such as the interleukin (IL)-6 has been approved.…”

The Effect of Acknowledged and Novel Anti-Rheumatic Therapies on Periodontal Tissues—A Narrative Review

“…Even though the early biological pathways through which the immune tolerance is affected and leads to the development and advancement of rheumatoid arthritis are unascertained, the importance of the inflammatory cascade is undisputed in the pathogenic evolution from autoimmune reaction until articular deterioration. The course of treatment in RA precisely targets specific elements of this inflammatory cascade [7]. For many years, treatment in rheumatoid arthritis has been symptomatic (steroidal and nonsteroidal anti-inflammatory analgesics), and largely non-effective, leading to joint destruction and deformation [8].…”