MANAGEMENT OF REFRACTORY RHEUMATOID ARTHRITIS [BIOLOGICALS IN RHEUMATOID ARTHRITIS (RA)

Abstract

Rheumatoid arthritis is complex immune disorder and chronic systemic inflammatory disease
that results in joint destruction and disability with multisystem involvement. Although with the
advent of different DMARDS treatment of this disease is possible to some extent, but prolonged
treatment course and adverse effects of the DMARDS are becoming its drawbacks and imposing
to switch to other modalities of treatment. Treatment involving Biologicals have revolutionized
the approach to this disease. These are found to target the pathologically involved cytokines such
as tumour necrosis factor (TNF) and immune cells like B cells. New cytokine directed therapies
target important proinflammatory mediators such as GM-CSF, new members of the IL-1 family,
IL-6 and its receptor, IL-17, IL-20, IL-21, IL-23 as well as synovium-specific targets. Biologics
are known to reduce the joint inflammation, limit erosions, decrease disability and improve
quality of life. Although infections and cost effectiveness of drug are limiting its wide use, their
use in conjunct with DMARDS (METHOTEXTRATE) has proven beneficial and is now the
new mode of novel approach to the patient with Rheumatoid Arthritis.