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Therapeutic advances in rheumatoid arthritis

Lookup NU author(s): Philip Brown, Dr Arthur PrattORCiD


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Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to arthritis (RA) is one of the most common immune mediated inflammatory diseases. People with rheumatoid arthritis present with pain, swelling, and stiffness that typically affects symmetrically distributed small and large joints. Without effective treatment, significant joint damage, disability, and work loss develop, owing to chronic inflammation of the joint lining (synovium). Over the past 25 years, the management of this condition has been revolutionized, resulting in substantially higher levels of disease remission and better long term outcomes. This improvement reflects a paradigm shift towards early and aggressive pharmacological intervention coupled with a proliferation in treatment choice, in turn related to enhanced pathobiological understanding and the advent of new drugs for rheumatoid arthritis. Following an overview of these developments from a historical perspective, and with a general audience in mind, this review focuses on newer, targeted treatments in an ever evolving landscape. The review highlights ongoing areas of debate and unmet need, including the proportion of patients with persistent, difficult-to-treat disease, despite recent advances. Also discussed are personalized, strategic approaches to individual patients, the role for imaging in clinical decision making, and the goal of sustained, drug free remission and disease prevention in the future.

Publication metadata

Author(s): Brown P, Pratt AG, Hyrich KL

Publication type: Review

Publication status: Published

Journal: BMJ

Year: 2024

Volume: 384

Pages: e070856

Online publication date: 17/01/2024

Acceptance date: 02/04/2018

ISSN (print): 1759-2151

ISSN (electronic): 0959-8138


DOI: 10.1136/bmj-2022-070856

PubMed id: 38233032