Management of refractory rheumatoid arthritis.

Based on the results of a MEDLINE search (1992-1997), the term 'refractory rheumatoid arthritis' (refractory RA) is ill-defined, in terms of both patient characterization and description of previous treatments. Current strategies of management of refractory RA include increasing disease-modifying anti-rheumatic drug dosage above standard dosage regimens, using combination therapy, and adding or increasing the dosage of corticosteroids. Options for further strategies include target-oriented biological agents (e.g. anti-tumour necrosis factor), gene therapy, stem-cell treatment and oral tolerance induction.