Contemporary approaches to the management of rheumatoid arthritis: precision and progress
Best Practice and Research: Clinical Rheumatology, vol.39, no.4, 2025 (SCI-Expanded, Scopus)
- Publication Type: Article / Review
- Volume: 39 Issue: 4
- Publication Date: 2025
- Doi Number: 10.1016/j.berh.2025.102106
- Journal Name: Best Practice and Research: Clinical Rheumatology
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Biotechnology Research Abstracts, CINAHL, EMBASE, MEDLINE
- Keywords: Biologic therapy, JAK inhibitors, Precision medicine, Rheumatoid arthritis
- Acibadem Mehmet Ali Aydinlar University Affiliated: Yes
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting synovial joints and extra-articular organs. While conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) like methotrexate remain the cornerstone of therapy, nearly half of patients demonstrate inadequate response to monotherapy. This review provides a comprehensive overview of the evolving therapeutic landscape in RA, covering standard therapies, novel treatments, and precision medicine approaches. The treatment landscape has dramatically expanded with biologic DMARDs targeting TNF-α, IL-6, B and T cells, and more recently, targeted synthetic DMARDs such as the Janus kinase inhibitors (JAKi). Emerging therapies are discussed, including innovative cell-based approaches, that will likely continue to revolutionize the treatment o. Furthermore, treatment failure, in the context of difficult-to-treat disease and factors associated with this, are addressed. We explore biomarker-driven treatment selection utilizing autoantibodies, imaging, and synovial tissue analysis and address key challenges around drug safety concerns, managing comorbidities and difficult-to-treat RA. Finally, this article concludes with reflections on future directions and the role of machine learning, multi-omics technologies, while maintaining the focus on patient-centered approaches to care.