[The meaning of biologic therapy in the treatment of rheumatoid arthritis with the focus on clinical remission. Part I. Tumor necrosis factor alpha inhibitors].

Aims of management of rheumatoid arthritis (RA) patients are not only a delay in progression of the disease and improvement of motor function, but also inhibition of progress of joint damage and achievement of remission. Early RA diagnosis is important, allowing introduction of active therapy as early as possible. Immediate treatment with disease modifying anti-rheumatic drugs (DMARDs) is necessary. In case DMARDs fail to evoke an adequate therapeutic response, introduction of biological drugs should be considered. Failure to achieve remission in case of many patients treated with classic DMARDs was a stimulus for intensive research on new drugs. Introduction of tumour necrosis factor alpha (TNF-alpha) inhibitors to therapy of RA 15 years ago caused a significant progress in management of the disease. Five TNF-alpha inhibitors are currently authorised (Infliximab, Etanercept, Adalimumab, Certolizumab and Golimumab) for RA treatment. Numerous clinical trials and observational programs proved higher efficacy of a combination therapy consisting of MTX and a TNF-alpha inhibitor in terms of RA remission. That applies mainly to patients burdened with risk factors of fast progression of the disease.