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This article is part of the supplement: B cell targeted therapy: a new approach to the treatment of rheumatoid arthritis

Highly Accessed Review

Unmet needs in rheumatoid arthritis

Larry Moreland

Author affiliations

University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA

Citation and License

Arthritis Research & Therapy 2005, 7(Suppl 3):S2-S8  doi:10.1186/ar1736

Published: 18 May 2005

Abstract

Until the pathophysiology/etiology of rheumatoid arthritis (RA) is better understood, treatment strategies must focus on disease management. Early diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs) are necessary to reduce early joint damage, functional loss, and mortality. Several clinical trials have now clearly shown that administering appropriate DMARDs early yields better therapeutic outcomes. However, RA is a heterogeneous disease in which responses to treatment vary considerably for any given patient. Thus, choosing which patients receive combination DMARDs, and which combinations, remains one of our major challenges in treating RA patients. In many well controlled clinical trials methotrexate and other DMARDs, including the tumor necrosis factor-α inhibitors, have shown considerable efficacy in controlling the inflammatory process, but many patients continue to have active disease. Optimizing clinical response requires the use of a full spectrum of clinical agents with different therapeutic targets. Newer therapies, such as rituximab, that specifically target B cells have emerged as viable treatment options for patients with RA.