Nascimento Melissa Macedo Peixoto, Azuelos Alef, Nóbrega Ivna Lacerda Pereira, Pitombeira Milena Sales, Martinez Ana Tereza Amoedo, de Carvalho Jozélio Freire, Rodrigues Carlos Ewerton Maia
Medical School, Universidade de Fortaleza, Ceará, Brazil.
Graduate Program in Medical Sciences, Universidade de Fortaleza (Unifor), Fortaleza, Brazil.
Mediterr J Rheumatol. 2025 Jun 30;36(2):149-158. doi: 10.31138/mjr.241124.ath. eCollection 2025 Jun.
Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease with substantial morbidity and socioeconomic burden. Early diagnosis and treatment are crucial to mitigate disease progression and preserve joint function. Current treatment strategies encompass non-pharmacological and pharmacological approaches, with disease-modifying antirheumatic drugs (DMARDs) being the cornerstone of pharmacotherapy. Novel immunomodulating drugs have revolutionised RA management by targeting specific cytokines or intracellular signalling pathways involved in disease pathogenesis. Evidence-based guidelines recommend biologics as second-line therapy for patients for whom conventional DMARDs have failed. While Tumour Necrosis Factor Inhibitors (TNFi) have traditionally been favoured, recent evidence suggests nuanced responses based on patient characteristics and treatment history are more effective. Moreover, Janus Kinase (JAK) Inhibitors emerge as a promising therapeutic option, demonstrating comparable efficacy to bDMARDs in clinical practice. Despite significant advancements, challenges in optimising RA treatment include variable treatment responses and safety concerns. Future research aims to refine treatment strategies, personalise therapeutic approaches, and elucidate disease mechanisms to improve outcomes for RA patients. The evolving landscape of immunomodulating drugs offers diverse therapeutic options for RA management. This article provides a comprehensive review of RA therapy, focusing on novel immunomodulating drugs.
类风湿关节炎（RA）是一种慢性自身免疫性炎症性疾病，具有较高的发病率和社会经济负担。早期诊断和治疗对于减轻疾病进展和保留关节功能至关重要。当前的治疗策略包括非药物和药物方法，其中改善病情抗风湿药（DMARDs）是药物治疗的基石。新型免疫调节药物通过靶向参与疾病发病机制的特定细胞因子或细胞内信号通路，彻底改变了类风湿关节炎的管理。循证指南推荐生物制剂作为传统DMARDs治疗失败患者的二线治疗。虽然肿瘤坏死因子抑制剂（TNFi）传统上更受青睐，但最近的证据表明，根据患者特征和治疗史进行细微调整的反应更有效。此外，Janus激酶（JAK）抑制剂成为一种有前景的治疗选择，在临床实践中显示出与生物DMARDs相当的疗效。尽管取得了重大进展，但优化类风湿关节炎治疗的挑战包括可变的治疗反应和安全问题。未来的研究旨在完善治疗策略、个性化治疗方法并阐明疾病机制，以改善类风湿关节炎患者的治疗效果。免疫调节药物不断变化的格局为类风湿关节炎的管理提供了多种治疗选择。本文对类风湿关节炎治疗进行了全面综述，重点关注新型免疫调节药物。
