Rheumatoid arthritis (RA) has witnessed significant advances in both understanding and treatment over the last few decades. From microscopic insights to macroscopic management strategies, the field of rheumatology has evolved dramatically. RA, a chronic systemic autoimmune disease, more frequently affects females and is commonly seen in the elderly. Its prevalence has become a global concern, with over 1.5% of the world’s population affected. This chronic autoimmune disorder is characterized by inflammation, swelling, and joint destruction, primarily targeting peripheral joints.
The economic burden of RA is substantial. In the United States, the yearly cost of chronic treatment varies significantly based on the type of medication used. For patients using non-biologic treatments, the cost is estimated at $12,509, with direct treatment costs amounting to $3,725. In contrast, for those on biologic agents, the total cost jumps to $36,053, with direct treatment expenses being $20,262 (Hresko et al., 2018).
RA is defined as a systemic autoimmune pathology, where a chronic inflammatory process can damage various organs including the heart, kidney, lung, digestive system, eyes, skin, and nervous system. The treatment landscape for RA has expanded with the introduction of biological DMARDs (Disease-Modifying Antirheumatic Drugs). These include TNF-targeting drugs, IL-6 receptor-targeting drugs, a B cell antigen CD20-targeting antibody, and a selective T cell costimulatory modulator. These biologics have proven highly effective and safe when combined with methotrexate (MTX), especially for RA refractory to MTX alone.
Significant strides have been made in developing disease-modifying antirheumatic drugs (DMARDs), greatly improving the management of RA. However, challenges remain as some patients do not respond adequately to these treatments. The 2019 EULAR recommendations have refined the use of DMARDs in treatment schedules, with a focus on new drug development, including Janus Kinase inhibitors (JAKis).
Recent research highlights the potential of inducing ferroptosis to deplete activated synovial fibroblasts in RA. Additionally, co-treatment with a TNF inhibitor can enhance this effect. This innovative approach opens new avenues in the treatment of RA, potentially leading to more effective strategies in managing this complex disease.
For more detailed information, explore these resources:
PMC
Nature
Nature Rheumatoid Arthritis
PubMed
Frontiers in Pharmacology
Frontiers in Immunology
Nature Reviews Rheumatology
