Inflammatory arthritis in the era of the biologics

Abstract

Over the last decade there have been some profound changes in the way we treat inflammatory arthritis. In the late 1980's and early 1990's, a significant philosophy change that had been underway for at least a decade was formalized with the concept of “inverting the pyramid”, which was to treat patients early and aggressively to prevent joint damage. In the late 1990's the biologic agents became available and these played into this concept of early aggressive therapy with their ability to affect inflammation rapidly and prevent joint damage. Currently the use of the biologic agents is undergoing some “fine tuning” as we add their power to older disease modifying agents such as methotrexate. New biologic agents are on the horizon that will hopefully add to the ability to diminish the impact of inflammatory arthritis. Cost and unknown long-term side effects add caution to the use of these agents. Rheumatologists finally have therapies that we do not need statisticians to tell us that they work; our patients demonstrate their efficacy to us daily.