Use of Biologics for Management of Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic, frequently progressive, and destructive autoimmune disease. As the disease progresses, irreversible joint damage may lead to loss of function and physical disability (World Health Organization, 2004). Patients with RA have reduced quality of life compared with healthy people. RA is associated with serious co-morbidities such as heart disease, infection, and malignancies (Boonen & Severens, 2011). This can result in a 5–10 year reduction in life expectancy (Kvien, 2004), reduced quality of life compared with other serious conditions (Lundkvist et al., 2008) and a considerable economic burden (Lundkvist et al., 2008). RA is a disabling disease, and the disability is usually measured by using a questionnaire called the Health Assessment Questionnaire (HAQ). Assement of Assessment for tenderness and swelling in the joints is one by the DAS (Disease Activity Score) for 28 joints. The counting of number of swollen and tender joints in the following 28-joints is done: 10 proximal interphalangeal joints (PIP), 10 metacarpo-phalangeal joints (MCP), 2 wrists, 2 elbows, 2 shoulders and 2 knees (Misra et al., 2008). Since this disease cannot be cured, management of this disease becomes an important endeavor with the aim of inducing and maintaining remission, and altering the course of disease. Disease Modifying AntiRheumatic Drugs (DMARDs, methotrexate followed by leflunoamide, sulfasalazine and hydroxychloroquine) are the recommended first line treatment for RA. However they are slow acting and toxicity monitoring is essential in patients on DMARDs (“Indian Guidelines”, 2002; Misra et al., 2008) Cortico-