Abstract

Rheumatoid arthritis (RA) is a common chronic inflammatory and destructive arthropathy that cannot be cured and that has substantial personal, social and economic costs.Methotrexate is a well-known folate analogue, and is the most frequently applied drug for the disease to modify antirheumatic therapy in patients with rheumatoid arthritis. Although results of studies have shown the efficacy of such drugs as methotrexate, on rheumatoid arthritis, activity measures and their effect on mortality in patients with the disease remain unknown. The current therapeutic approach to rheumatoid arthritis consists of administration of anti-inflammatory, immunomodulating, and immunosuppressive drugs. Immunomodulating drugs, as opposed to non-steroid anti-inflammatory drugs, which only reduce the signs of inflammation,are capable of gradually checking the course of the disease. However, they do not prevent the slow but progressive destruction of joints. The prominent role of proinflammatory cytokines and growth factors in the pathogenesis of RA has been documented. Recent studies have demonstrated the efficacy of anticytokine treatment.Infliximab is a chimeric monoclonal antibody capable of neutralizing human TNF alpha. A number of clinical trials for the treatment of rheumatoid arthritis with infliximab indicated that TNF alpha blockade was effective and well tolerated, with excellent results occurring at 3 and 10 mg/kg in combination with methotrexate. Treatment of RA patients with the combination of infliximab and methotrexate also prevented radiographic evidence of progression of joint damage.If its clinical efficacy is sustainable and its safety confirmed over the long term, infliximab may become an essential agent of choice for the treatment of RA.

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