Is non-biological treatment of rheumatoid arthritis as good as biologics?

doi:10.5312/wjo.v6.i2.278

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World Journal of Orthopedics

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World J Orthop. Mar 18, 2015; 6(2): 278-283
Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.278

Is non-biological treatment of rheumatoid arthritis as good as biologics?

Jyoti Ranjan Parida, Durga Prasanna Misra, Anupam Wakhlu, Vikas Agarwal

Jyoti Ranjan Parida, Durga Prasanna Misra, Vikas Agarwal, Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India

Anupam Wakhlu, Department of Rheumatology, King George’s Medical University, Lucknow 226014, India

Author contributions: All the authors have contributed equally in collecting references, conceptualizing and interpreting data, designing manuscript, writing manuscript including revision and final approval.

Correspondence to: Dr. Vikas Agarwal, Additional Professor, Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, India. vikasagr@sgpgi.ac.in

Telephone: +91-52-22494318 Fax: +91-52-22668812

Received: February 12, 2014
Peer-review started: February 13, 2014
First decision: March 26, 2014
Revised: April 10, 2014
Accepted: September 6, 2014
Article in press: September 10, 2014
Published online: March 18, 2015
Processing time: 399 Days and 23.4 Hours

Abstract

The management of rheumatoid arthritis (RA) in the past three decades has undergone a paradigm shift from symptomatic relief to a “treat-to-target” approach. This has been possible through use of various conventional and biologic disease modifying anti-rheumatic drugs (DMARDs) which target disease pathogenesis at a molecular level. Cost and infection risk preclude regular use of biologics in resource-constrained settings. In the recent years, evidence has emerged that combination therapy with conventional DMARDs is not inferior to biologics in the management of RA and is a feasible cost-effective option.

Keywords: Rheumatoid arthritis; Disease modifying drugs; Biologics; Methotrexate; Sulfasalazine; Leflunomide; Cyclosporine; Hydroxychloroquine; Tumor necrosis factor; Remission; Radiologic outcome

Core tip: In developing world cost of treatment remains a major concern. Recent evidences are emerging that support the equal efficacy of conventional disease modifying anti-rheumatic drugs (DMARDs) as compared to biological DMARDs. In this review we have presented evidences supporting conventional DMARDs in management of rheumatoid arthritis.