Vol.23 No.1

Review Article

Management of rheumatoid arthritis: the 2012 perspective

Authors

Hisashi Yamanaka1 , Yohei Seto1 , Eiichi Tanaka1 , Takefumi Furuya1 , Ayako Nakajima1 , Katsunori Ikari1 , Atsuo Taniguchi1 , Shigeki Momohara1

  • Institute of Rheumatology, Tokyo Women’s Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan
Received:

9 April 2012

Accepted:

11 June 2012

Published online:

7 July 2012

Full Text

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Abstract

Management of rheumatoid arthritis (RA) has improved over the last 10 years. These changes have been monitored in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) observational cohort, and clinical remission has become a realistic goal. However, we should recognize that the ultimate goal of treatment is to improve long-term outcomes. These improvements have been achieved not only by new drugs, but also by the overall approach toward treating patients. Biologics in RA have been successful; however, safety concerns and pharmacoeconomical issues are still debated. Protein kinase inhibitors have been developed, and can be called “moleculartargeting antirheumatic drugs” (MTARDs), as opposed to “disease-modifying antirheumatic drugs.” In comparison with biologics, oral MTARDs should be less expensive; however, their safety profile should be confirmed. Considering the limitations of randomized trials, it is encouraged to conduct studies based on daily practice. It is time to consider the application of the evidence generated from “our” patients to patients in daily practice, namely institutebased medicine as opposed to evidence-based medicine, of which “IORRA-based medicine” would be representative. Finally, there remains much for us rheumatologists to do for our patients, including patient-perspective approaches.

Key words

Outcome - Observational cohort - Biologics - MTARDs - Patient perspective