Recent Advancements in Rheumatology Treatment

New Therapeutic Agents and Approaches

The development of biologics and small oral molecules has revolutionized the pharmacologic treatment of systemic rheumatic diseases by targeting specific molecular or cellular pathways directly involved in disease pathogenesis, according to Autoimmunity Reviews 1
TNF inhibitors, including adalimumab, certolizumab pegol, etanercept, golimumab, and infliximab, remain cornerstone biologics with proven efficacy in reducing clinical signs of inflammation in patients who have failed conventional DMARDs, as reported by Autoimmunity Reviews 1
IL-6 pathway inhibitors, such as tocilizumab and sarilumab, have shown effectiveness as both monotherapy and in combination with methotrexate, according to Annals of the Rheumatic Diseases 2
T-cell costimulation modulator, abatacept, and anti-CD20 antibody, rituximab, provide options for patients with inadequate response to TNF inhibitors, as stated by Annals of the Rheumatic Diseases 2
IL-17 inhibitors, such as secukinumab and ixekizumab, have been approved for psoriatic arthritis and axial spondyloarthritis, according to Autoimmunity Reviews 4
JAK inhibitors, including tofacitinib, baricitinib, filgotinib, and upadacitinib, have demonstrated efficacy in rheumatoid arthritis, as reported by Annals of the Rheumatic Diseases 2

The 2019 EULAR recommendations emphasize a treat-to-target approach aiming for remission or low disease activity in rheumatoid arthritis patients, according to Annals of the Rheumatic Diseases 2
Initial therapy recommendations include methotrexate plus short-term glucocorticoids, as stated by Annals of the Rheumatic Diseases 2
For inadequate response to initial therapy within 3-6 months, treatment should be stratified according to risk factors, such as autoantibodies, high disease activity, early erosions, or failure of two csDMARDs, as reported by Annals of the Rheumatic Diseases 2
In patients with poor prognostic factors, any bDMARD or JAK inhibitor should be added to csDMARDs, according to Annals of the Rheumatic Diseases 2
Treatment tapering, but not discontinuation, is recommended for patients in sustained remission, as stated by Annals of the Rheumatic Diseases 2
Updated ASAS-EULAR recommendations now incorporate the entire disease spectrum, including both radiographic and non-radiographic axial spondyloarthritis, according to Autoimmunity Reviews 4
Treatment guidelines from GRAPPA, EULAR, and ACR/NPF have been updated to incorporate new therapies and address comorbidities in psoriatic arthritis patients, as reported by Autoimmunity Reviews 4

Presence of rheumatoid factor, anti-citrullinated protein antibodies, or elevated serum IgG may predict better response to rituximab, according to Praxis Medical Insights: Practical Summaries of Clinical Guidelines, but a more reliable source, Annals of the Rheumatic Diseases, was not found for this specific fact 3
Research continues to identify reliable biomarkers for diagnosing rheumatic diseases and predicting treatment response, as reported by Autoimmunity Reviews 8

The availability of biosimilars offers the opportunity to reduce treatment costs while maintaining efficacy, according to Autoimmunity Reviews 1
Economic considerations are increasingly important in treatment decisions, with recommendations that the least expensive bDMARD should be used in treatment-naïve patients, as stated by Autoimmunity Reviews 8

Despite advances, reliable biomarkers for personalizing treatment remain limited, according to Autoimmunity Reviews 8
Treatment decisions increasingly consider comorbidities, with specific guidelines developed for managing RA patients with diabetes, inflammatory bowel disease, and high infection risk, as reported by Autoimmunity Reviews and Arthritis care & research 1, 9

Delaying DMARD initiation after diagnosis can lead to irreversible joint damage, according to Praxis Medical Insights: Practical Summaries of Clinical Guidelines, but a more reliable source, Annals of the Rheumatic Diseases, was not found for this specific fact, however, Annals of the Rheumatic Diseases does report that failure to adjust therapy when treatment targets are not met within the recommended timeframes can lead to poor outcomes 3, 2
Failure to adjust therapy when treatment targets are not met within the recommended timeframes (improvement by 3 months, target by 6 months) can lead to poor outcomes, as reported by Annals of the Rheumatic Diseases 2
Overlooking comorbidities that may influence treatment selection, such as hepatitis, tuberculosis, or heart failure, can lead to poor outcomes, according to Arthritis care & research and other sources 9