Abstract
Rheumatoid arthritis (RA) is characterized by chronic inflammatory synovitis that causes pain, loss of function and disability, and can significantly reduce health-related quality of life. Improved understanding of the disease pathogenesis has led to the development of new biologic treatments that target specific cytokines. Large randomized controlled trials (RCTs) have been conducted to show the efficacy of anti-TNF and IL-6. However, despite these treatments, some patients fail to respond to these therapies. Recently, novel anti-cytokine treatments have been developed and introduced. Certolizumab pegol treatment with and without non-MTX disease-modifying anti-rheumatic drugs (DMARDs) in Japanese patients, to whom MTX cannot be administered, resulted in rapid, sustained reductions in RA signs and symptoms. Drug-based treatments, such as DMARDs and biologic agents, have evolved markedly over the past 2 decades and have reduced the need for joint replacements. Thus, surgical treatment of RA using joint replacements has decreased dramatically. In particular, the decline was greater for lower-limb and spinal operations than for upper-limb operations.
