ABSTRACT
The active search for new treatment modalities for established rheumatoid arthritis (RA) has created a dynamic period for rheumatology. Both innovative application of established diseasemodifying anti-rheumatic drugs (DMARDs) and the availability of targeted interventions have improved therapeutic results. The emphasis in RA clinical research has been on measures of inflammatory activity such as joint scores and acute phase response. Control of inflammation is regarded as an effective strategy to improve long-term outcome, although few studies are available to assess how completely inflammation must be controlled. The benefit of early treatment is indisputable, as is tight disease control to detect non-responders in an early phase.1,2 In the last 5 years the results of many studies have emerged that allow an optimal introduction of tumor necrosis factor (TNF) antagonists in the treatment armamentarium of rheumatologists. Given the availability of three TNF antagonists, the emergence of two new targeted therapies in RA (abatacept and rituximab) and the judgment on clinical efficacy, the usage of recombinant interleukin (IL)-1 receptor antagonist has sharply declined. This chapter will focus on the new insights in efficacy and toxicity of TNF antagonists obtained between 2001 and 2006.
