Newer approaches to the treatment of rheumatoid arthritis.

Growing evidence suggests that rheumatoid arthritis should no longer be considered a benign disease. Considerable data suggest that this disease is associated with diminished long-term survival. Other studies have also shown that in patients with rheumatoid arthritis, bone damage can occur very early in the disease course. Older disease modifying agents for treating rheumatoid arthritis were limited by long-term toxicity. Newer agents, including methotrexate, leflunomide, and the biologic agents etanercept, infliximab, adalimumab, and anakinra have shown long-term efficacy and superior long-term tolerability. Newer approaches to treating this disease have stressed treatment early in the disease course, before irreversible joint damage occurs, using combinations of second line disease modifying agents.