2023 年 7 巻 p. 21-33
Cell-surface antigens, cytokines, receptors, and signal transduction molecules that are central in the pathogenesis of rheumatic diseases have been elucidated, and therapeutic targets have been identified. Molecular-targeted drugs are now available for the treatment of rheumatoid arthritis and other diseases, including psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis. These targeted drugs have shown the potential for achieving clinical remission in many rheumatic diseases. Tumor necrosis factor and interleukin-6 (IL-6) play major roles in rheumatoid arthritis, whereas IL-17 and IL-23 play crucial roles in spondyloarthritis. Biological disease-modifying anti-rheumatic drugs that specifically inhibit the actions of these cytokines and targeted synthetic disease-modifying anti-rheumatic drugs, such as Janus kinase inhibitors, have been approved, increasing the available treatment options. Molecular-targeted drugs also hold promise for the treatment of collagen diseases, including systemic lupus erythematosus, systemic sclerosis, and vasculitis. However, drawbacks related to their use persist, including high drug costs and the risk of adverse events, such as infectious diseases. Therefore, the criteria for selecting patients who are most likely to benefit from these drugs should be developed.
