Progress in the treatment of rheumatic disease

The progress in defining the immunological and inflammatory mechanisms that lead to the progressive joint destruction in rheumatoid arthritis (RA) [1,2] has led to the development of new inhibitory drugs. Large randomized controlled trials have shown the efficacy of the new treatments and led to the recent approval of several new drugs by American and European health authorities. These are the COX2 inhibitors rofecoxib and celecoxib, the anti-metabolite leflunomide, and the ‘biologicals’, the TNFa neutralizing substances etanercept and infliximab and the IL1-receptor antagonist anakinra. At the same time, epidemiological investigations have started to describe the socio-economic consequences of inflammatory joint diseases, which often start at a young age and lead to retirement in 50% of the patients in the initial 3 years of the disease [3]. Analysing the outcome of patients with RA, responsive or not to methotrexate (MTX) treatment, it could be shown that compared with age-matched healthy persons, patients with RA without efficient treatment have a )4-fold increased standardized mortality ratio. This is reduced to 1.5-fold by MTX and probably other efficient treatments [4]. For the evaluation of the patient before and during treatment, the DAS28 (disease activity score) has been developed as a standardized evaluation instrument using the swollen and tender joint count of 28 joints, the serologic inflammation and the patients self assessment of pain [5]. Since the nephrologist will see many patients with rheumatic disorders, it is useful to stay updated on recent progress in rheumatology.