State-of-the art treatment strategy for rheumatic diseases

Abstract

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by inflammation and joint destruction that causes significant morbidity and mortality. However, the combined use of methotrexate and biologics targeting TNF and IL-6 has revolutionized treatment of RA. Clinical remission is now realistic targets, achieved by a large proportion of RA patients, and rapid and appropriate induction of remission by the intensive treatment is prerequisite to halt joint damage and functional disabilities. Recently, orally available small molecules targeting Janus kinase (JAK) has taken in the therapeutic armamentarium in RA. Such a progress in treatments with biologics and JAK inhibitors of RA is now applied for various rheumatic diseases and systemic autoimmune diseases. Furthermore, treatment holiday of biologics is feasible in some patients with RA after maintaining deep remission by the intensive treatments, which has the potential of reducing adverse effects and medical costs as well as approaching to immunological remission. Finally, we currently try to treat patients with different biologics targeting TNF, IL-17 and IL-12/IL-23 based on the difference of lymphocyte phenotype. Such a treatment strategy should be guided by molecular, cellular and/or immunological mechanisms and a systematic approach to design a precision medicine to rheumatic diseases should help to achieve the goal.