Rheumatoid arthritis 2

Published on May 31, 2020   26 min

A selection of talks on Immunology & Inflammation

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Welcome to this second part of the Henry Stewart Talk about "Rheumatoid Arthritis". My name is Peter Taylor, Professor of Musculoskeletal Sciences at the University of Oxford. In this second part of the talk, we're going to consider approaches to treatment. Look at the current drugs available for the management of rheumatoid arthritis, and how they're used in contemporary practice. In part 1 of this Henry Stewart's lecture, we considered the nature of rheumatoid arthritis, how it's diagnosed or classified, its presentation, and the pathobiology.
So, having looked at the background of the pathogenesis and the history of rheumatoid arthritis and its classification, now let's turn our attention to contemporary treatment.
So, what are the goals of treatment, if we look at this next slide? Well, the overall goals are to assess disease activity and response to therapy with a view to achieving remission where possible. This is done with the help of various pharmacotherapeutic agents. And we're going to look at the meaning of these. There are a range of drugs used, and we'll ask the question, what's a DMARD? And there are many different types, conventional synthetic DMARDs, biologic DMARDs, and targeted synthetic DMARDs. And we'll look briefly at the safety and also some non-pharmacological interventions.
So, the European League Against Rheumatism and the American College of Rheumatology have made recommendations for the management of rheumatoid arthritis which are very good. And essentially, this requires a goal-oriented treatment approach. The primary target for treatment is remission where possible, or low disease activity as a secondary goal if remission is not attainable. And the treatment should start as soon as possible, once the diagnosis or classification is being made. The patient is seen regularly with a view to adjusting the treatment, and then titrating treatment according to response, until ideally, the treatment goal is achieved. It should be said, however, that even in best practice centers that it's not always possible to achieve the aspirational goal of remission, or low disease activity. The treat-to-target concept follows these principles really with an idea of