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ID PMID Title PublicationDate abstract
19078861 [Is the response to anti-TNFalpha treatment influenced by the presence of IgM rheumatoid f 2008 Oct AIM: To verify if the response to TNFalpha inhibitors is influenced by the presence of IgM rheumatoid factor (RF), in patients with RA. MATERIAL AND METHODS: In this study, the patients with the diagnosis of RA treated with TNFa inhibitors followed in our hospital were recruited. A protocol was applied including demographic, clinical and laboratory data, in order to calculate DAS 28. The presence/absence of IgM RF and associated therapies were record. RESULTS: Fifty-seven patients, 52 female, with a mean duration of anti-TNFa treatment of 30,9+/-15,9 months were studied. Twenty-four patients were being treated with infliximab, 17 with adalimumab and 16 with etanercept. Forty-one patients had IgM RF detectable in serum (RF positive group). In the RF positive group, the variation of DAS 28 was -1,75 +/- 1,53 vs -1,04 +/- 1,76 in the RF negative group (p=0,135). The mean duration of anti-TNFalpha treatment was similar in both groups (31,9+/-15,9 vs 29,5+/-16,16 months). Patients who were treated with methotrexate presented a higher variation of DAS 28 (-1,87 +/- 1,70 vs -0,80 +/- 1,09; p=0,041) and this variation was dose dependent (p=0,056). CONCLUSIONS: Despite needing a replication in a larger cohort, our results suggest that the presence of IgM RF in the serum did not interfere with the response to treatment with TNFalpha inhibitors.
18192304 Cost effectiveness of the determination of autoantibodies against cyclic citrullinated pep 2008 Oct OBJECTIVE: To estimate the incremental cost-effectiveness ratio (ICER) of antibodies against cyclic citrullinated peptides (aCCP) in the early diagnosis of rheumatoid arthritis (RA). METHODS: A Markov model was used to model 10-year progression of RA in patients first diagnosed with undifferentiated arthritis (UA) and to estimate the incremental costs and quality-adjusted life years (QALYs) of using aCCP additionally to American College of Rheumatology (ACR) criteria. The impact of later diagnosis and treatment due to non-use of aCCP was modelled as increased Health Assessment Questionnaire (HAQ) progression. Utilities were assigned to HAQ states for calculating QALYs. Uncertainty was analysed using univariate and probabilistic sensitivity analyses (Monte Carlo simulation). RESULTS: Baseline ICER was euro 930/QALY. Univariate sensitivity analyses identified the impact of later diagnosis on HAQ progression as a major source of uncertainty, resulting in an ICER range from "dominance" to euro 153 092/QALY, compared with a maximum ICER of euro4870/QALY for other variables. Monte Carlo simulation resulted in a 95% uncertainty interval from euro 3537/QALY (dominance) to euro 5429/QALY; when indirect costs were considered, Monte Carlo simulation resulted in a 95% uncertainty interval from euro 78 115/QALY (dominance) to -euro 23 444/QALY (dominance). CONCLUSIONS: Using aCCP in the diagnosis of RA in patients with UA is likely to be cost effective compared with using ACR criteria alone. When indirect costs are incorporated, aCCP seems to save costs. Clearly, more research is needed relating the effects of diagnosis and treatment on the long-term course and the resulting functional impairment of RA as measured by the HAQ.
16739186 Rheumatology care: Involvement in medical decisions, received information, satisfaction wi 2006 Jun 15 OBJECTIVE: To examine levels of received information, involvement in medical decisions, and satisfaction with care, to explore factors related to current involvement in medical decisions, and to assess patients' unmet health care needs related to their disease. METHODS: A total of 1,193 patients with rheumatoid arthritis and ankylosing spondylitis completed self-reported health status questionnaires, including registration of sociodemographic data and questions about rheumatology care. Separate questions addressed information received, involvement in decisions, and satisfaction with care. Aspects of unmet health were assessed by an open-ended question. RESULTS: The majority of patients reported medium to high levels of received information, involvement in medical decisions, and satisfaction with care. High involvement in medical decisions was univariately associated with high levels of perceived information and satisfaction, as well as with lower age and a good health status. In the multivariate analyses, patient satisfaction (odds ratio [OR] 4.21) and a high level of received information (OR 7.85), age (OR 0.99), and >12 years of formal education (OR 1.46) remained as significant predictors to current involvement. Nearly one-third reported a variety of unmet health care needs, and this report was associated with poor health. CONCLUSION: The results indicate a need for a more flexible and patient centered care model, in which patients to a larger degree can decide which services they need and how these services should be delivered.
17265479 Angiotensin II type 1 receptor as a novel therapeutic target in rheumatoid arthritis: in v 2007 Feb OBJECTIVE: Angiotensin II (Ang II) is known to have proinflammatory actions, and Ang II type 1 (AT(1)) receptors are up-regulated in the rheumatoid synovium, suggesting that this receptor could be a therapeutic target. The purpose of this study was to investigate the antiinflammatory potential of the selective AT(1) receptor antagonist losartan, which is currently used for the treatment of cardiovascular disease. METHODS: Dose-ranging studies of losartan (1-50 mg/kg) were initially conducted in a rat model of acute (carrageenan/kaolin) arthritis, with subsequent evaluation in a rat model of adjuvant-induced arthritis (Freund's complete adjuvant). Losartan (10(-10) to 10(-6)M) was further tested ex vivo in human inflammatory synovitis, using collagenase-digested synovium. RESULTS: Western blot and immunohistochemical analyses both revealed a substantial increase in AT(1) receptor protein content in synovium from acutely and chronically inflamed rat knee joints. Similarly, synovial Ang I/II protein content was elevated during inflammation. Losartan inhibited acute joint inflammation in a dose-dependent manner, with 15 mg/kg being the optimal dose (and used in subsequent studies). Both prophylactic and therapeutic administration of 15 mg/kg of losartan substantially reduced knee joint swelling in rats with adjuvant monarthritis (> or =50%; P < 0.0001). Losartan also suppressed tumor necrosis factor alpha generation from inflamed human synovium in a dose-dependent manner (P < 0.05). CONCLUSION: Targeting the angiotensin pathway, particularly AT(1) receptors, could have significant therapeutic potential. Randomized placebo-controlled trials are now warranted to establish the extent to which angiotensin receptor blockers may provide antiinflammatory benefits.
17553139 The PTPN22 1858C/T polymorphism is associated with anti-cyclic citrullinated peptide antib 2007 The PTPN22 1858C/T polymorphism has been associated with several autoimmune diseases including rheumatoid arthritis (RA). We have shown that carriage of the T variant (CT or TT) of PTPN22 in combination with anti-cyclic citrullinated peptide (anti-CCP) antibodies highly increases the odds ratio for developing RA. In the present study we analysed the association between the PTPN22 1858C/T polymorphism and early RA in patients from northern Sweden, related the polymorphism to autoantibodies and the HLA-DR shared epitope, and analysed their association with markers for disease activity and progression. The inception cohort includes individuals who also donated samples before disease onset. A case-control study was performed in patients (n = 505; 342 females and 163 males) with early RA (mean duration of symptoms = 6.3 months) and in population-based matched controls (n = 970) from northern Sweden. Genotyping of the PTPN22 1858C/T polymorphism was performed using a TaqMan instrument. HLA-shared epitope alleles were identified using PCR sequence-specific primers. Anti-CCP2 antibodies were determined using enzyme-linked immunoassays. Disease activity (that is, the number of swollen and tender joints, the global visual analogue scale, and the erythrocyte sedimentation rate) was followed on a regular basis (that is, at baseline and after 6, 12, 18 and 24 months). Both the 1858T allele and the carriage of T were associated with RA (chi2 = 23.84, P = 0.000001, odds ratio = 1.69, 95% confidence interval = 1.36-2.11; and chi2 = 22.68, P = 0.000002, odds ratio = 1.79, 95% confidence interval = 1.40-2.29, respectively). Association of the 1858T variant with RA was confined to seropositive disease. Carriage of 1858T and the presence of anti-CCP antibodies was independently associated with disease onset at an earlier age (P < 0.05 and P < 0.01, respectively), while the combination of both resulted in an even earlier age at onset. Smoking was identified as a risk factor independent of the 1858T variant and anti-CCP antibodies.
16385495 The effectiveness of anti-tumor necrosis factor therapy in preventing progressive radiogra 2006 Jan OBJECTIVE: To compare the effectiveness of 3 therapeutic strategies in preventing progressive joint damage, in a population-based cohort. The 3 strategies were infliximab with concomitant disease-modifying antirheumatic drugs (DMARDs), etanercept with concomitant DMARDs, and etanercept alone. METHODS: We used sequential radiographs to assess all patients who were treated with infliximab or etanercept for >10 months. The rates of erosion progression and joint space narrowing (JSN) were analyzed using multivariate regression models for longitudinal data, with adjustment for potential confounders. RESULTS: A total of 372 patients treated with anti-tumor necrosis factor (TNF) therapies met the inclusion criteria. The baseline characteristics of the patients assigned to the 3 strategies were not significantly different, except that, as expected, more patients were receiving combination therapy with infliximab. The combination of infliximab plus DMARDs was significantly more effective than etanercept alone for controlling erosion progression (P < 0.001), but the effectiveness of the 2 combination-treatment strategies was similar (P = 0.07). The combination of infliximab plus DMARDs was also more effective at controlling progressive JSN compared with etanercept alone (P = 0.04) or etanercept plus DMARDs (P = 0.02). Treatment with anti-TNF agents (infliximab or etanercept) plus concomitant DMARDs was more effective than treatment with etanercept alone for controlling erosion progression (P = 0.045). CONCLUSION: When combined with traditional DMARDs, both etanercept and infliximab appear to offer similar protection against progressive structural joint damage, and combination therapy with either of these agents appears to be more effective than treatment with etanercept alone.
18573197 The association between disease activity and NT-proBNP in 238 patients with rheumatoid art 2008 INTRODUCTION: Disease activity in patients with rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality, of which N-terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor. Our objective was to examine the cross-sectional and longitudinal associations between markers of inflammation, measures of RA disease activity, medication used in the treatment of RA, and NT-proBNP levels (dependent variable). METHODS: Two hundred thirty-eight patients with RA of less than 4 years in duration were followed longitudinally with three comprehensive assessments of clinical and radiographic data over a 10-year period. Serum samples were frozen and later batch-analyzed for NT-proBNP levels and other biomarkers. Bivariate, multivariate, and repeated analyses were performed. RESULTS: C-reactive protein (CRP) levels at baseline were cross-sectionally associated with NT-proBNP levels after adjustment for age and gender (r2 adjusted = 0.23; P < 0.05). At the 10-year follow-up, risk factors for cardiovascular disease were recorded. Duration of RA and CRP levels were independently associated with NT-proBNP in the final model that was adjusted for gender, age, and creatinine levels (r2 adjusted = 0.38; P < 0.001). In the longitudinal analyses, which adjusted for age, gender, and time of follow-up, we found that repeated measures of CRP predicted NT-proBNP levels (P < 0.001). CONCLUSION: CRP levels are linearly associated with levels of NT-proBNP in cross-sectional and longitudinal analyses of patients with RA. The independent associations of NT-proBNP levels and markers of disease activity with clinical cardiovascular endpoints need to be further investigated.
17223658 Effects of intra-articular corticosteroids and anti-TNF therapy on neutrophil activation i 2007 Aug OBJECTIVE: The pro-inflammatory calcium-binding protein S100A12 has been recently ascribed to the novel group of damage associated molecular pattern (DAMP) molecules. Serum levels of S100A12 reflect neutrophil activation during synovial inflammation. The aim of this project was to analyse the effect of intra-articular corticosteroids or systemic anti-TNF treatment on synovial expression and serum levels of S100A12 in rheumatoid arthritis (RA). METHODS: Serum and synovial tissue was obtained from 19 RA patients prior to and 2 weeks after intra-articular corticosteroid therapy. Serum was collected for 34 other patients, and in 14 of these patients synovial tissue was additionally obtained prior to and after 8 weeks of infliximab treatment. The expression of S100A12 was analysed by immunohistochemistry on frozen sections. Levels of S100A12 in serum were determined by ELISA. RESULTS: S100A12 serum levels were elevated in patients with active RA prior to therapy and decreased significantly in patients who responded to treatment in both patient groups, but not in non-responders. The synovial expression of S100A12 was reduced 2 weeks after successful intra-articular corticosteroid treatment. A similar decrease in local expression was found after 8 weeks of successful infliximab treatment. CONCLUSIONS: Successful treatment of RA leads to downregulation of the DAMP protein S100A12. Expression and secretion of S100A12 is rapidly diminished after therapy with intra-articular corticosteroids or infliximab. Taking these findings together, decreasing serum concentrations of S100A12 could reflect alleviated synovial neutrophil activation during successful anti-inflammatory therapy in RA.
19166383 IL-7 and IL-15: biology and roles in T-Cell immunity in health and disease. 2008 Cytokines IL-7 and IL-15 are essentially involved in T-cell homeostasis. IL-7 is required for developing mature T cells in the thymus, whereas in the periphery, it promotes the survival of naïve and memory T cells by upregulating the antiapoptotic molecule Bcl-2. IL-15 potently induces the proliferation of memory CD8+ T cells independently of antigen and augments their effector function. Although IL-7 and IL-15 may help to defend the host against microorganisms and tumors by promoting T-cell immunity, dysregulated production of IL-7 and IL-15 can be harmful. In fact, increased levels of IL-15 in the circulation and inflamed tissues have been reported in various autoimmune diseases, including rheumatoid arthritis (RA), possibly contributing to the pathogenesis. In addition, IL-7, which may induce the production of inflammatory cytokines from T cells and monocytes, are found to be elevated in the joints of patients with RA. Here, we review what is currently known about the roles of these cytokines in T-cell immunity, in general, as well as in RA, in particular, focusing on recent discoveries.
17332981 Nodular pulmonary amyloidosis in a patient with rheumatoid arthritis. 2007 Oct We describe a 67-year-old white woman with a long-standing active rheumatoid arthritis who refused treatment. Chest roentgenograms performed in 2000 revealed a pulmonary nodule in the mid-left lung. Progression of the nodule was followed annually by computerized tomography (CT). In the last CT in 2002, we observed multiple nodules in both lungs in the absence of lymph gland involvement. The patient was operated by video-thoracoscopy to resect one of the pulmonary nodules. Pathological examination of the excised tissue revealed amyloid A-type (AA) amyloidosis. Although pulmonary amyloidosis is rare in patients with systemic AA amyloidosis, we recommend that this possibility be considered when confronted with a patient with these characteristics.
16339290 Declines in number of tender and swollen joints in patients with rheumatoid arthritis seen 2006 Jul OBJECTIVE: To analyse tender and swollen joint counts in three cohorts of patients with rheumatoid arthritis (RA), with a focus on the proportions of patients who had fewer than 6-12 tender or swollen joints, as possible evidence based information toward more generalisable inclusion criteria for current and future RA clinical trials. METHODS: Tender and swollen joint counts were analysed in three cohorts of patients with RA: 125 in 1985, 138 in 2000, and 232 with early RA in 2001. RESULTS: The median numbers of tender joints were 11, 2, and 4 in 1985, 2000, and in early RA in 2001, respectively. The median numbers of swollen joints were 12, 6, and 5 in 1985, 2000, and 2001, respectively. The numbers of tender joints among 28 assessed were >or=12, >or=6, >or=4, and >or=3 in 47%, 80%, 85%, and 90% of patients in 1985; 20%, 37%, 44%, and 49% in 2000; and 17%, 37%, 50%, and 58% in early RA in 2001. The numbers of swollen joints among 28 assessed were >or=12, >or=6, >or=4, and >or=3 in 51%, 78%, 86%, and 90% of patients in 1985; 20%, 50%, 64%, and 67% in 2000; and 14%, 46%, 58%, and 72% in 2001. The number of patients with >or=6 tender or swollen joints in 1985 was greater than the number with >or=3 joints in 2000 and in early RA in 2001. CONCLUSION: Contemporary cohorts of patients seen in standard care have smaller numbers of tender and swollen joints than in previous times. These findings suggest that revision of inclusion criteria for numbers of tender and swollen joints in contemporary RA clinical trials might improve generalisability.
18576921 Improvement of agreement in TCM diagnosis among TCM practitioners for persons with the con 2008 May OBJECTIVE: To investigate whether a training process that focused on consensus on Traditional Chinese Medicine (TCM) diagnostic criteria will improve the agreement of TCM diagnosis on patients with rheumatoid arthritis (RA). DESIGN: The design was a prospective survey. SETTING: The study was conducted at the General Clinical Research Center, University of Maryland Hospital System, Baltimore, MD. SUBJECTS: The participants were 42 patients with RA. PRACTITIONERS: The practitioners included 3 licensed acupuncturists with a minimum of 5 years' licensure and education in Chinese herbs. METHODS: A training session of TCM diagnostic procedures was conducted with an open case discussion and "real time" practice. After the training, 3 TCM practitioners examined the same 42 patients with RA separately. Patients filled out a questionnaire to serve as the data for the "Inquiry" component while physical examinations, including observations of tongue and palpation of radial pulse, were conducted by the 3 practitioners. Each practitioner provided a TCM diagnosis based upon the examination results. These diagnoses were then examined with respect to the rate of agreement among the 3 practitioners. RESULTS: The average agreement with respect to the TCM diagnoses among the 3 pairs of TCM practitioners was 73% (64.3%-85.7%). Statistically significant differences were found between this study and the two previous studies (p < 0.001). CONCLUSIONS: After training focused on consensus on TCM diagnostic criteria, we found that these 3 same TCM practitioners who were used in phase II of the study produced a significantly higher agreement when compared to study phase I or phase II. Our study suggests that improved consensus on TCM diagnostic criteria results in increased agreement of diagnosis.
16877837 Spontaneous esophageal perforation in a patient with achalasia cardia and rheumatoid arthr 2006 May Perforation of stasis ulcers in achalasia cardia has not been reported in literature. We report a 45-year-old lady with achalasia and rheumatoid arthritis who developed perforation and esophago-mediastinal sinus at the site of stasis ulcers. She succumbed to respiratory infection after resection of the sinus tract, Heller's cardiomyotomy, cervical esophagostomy and feeding jejunostomy.
17336025 Feasibility and induced cognitive-emotional change of an emotional disclosure intervention 2007 May OBJECTIVE: Emotional engagement, cognitive restructuring, and positive future directedness are considered core elements to induce change in emotional disclosure interventions. Our aim was to examine the induction of these elements and the feasibility of an emotional disclosure intervention adapted for home application. METHODS: The intervention emphasized expression of negative and positive emotions (session 1-4), search for meaning (session 3), and a positive future-oriented ending (session 4). A randomized clinical trial in patients with rheumatoid arthritis compared the adapted intervention (n=40) with a time management control condition (n=28). Feasibility was evaluated regarding adherence, compliance with instructions, perceived viability, and clinical safety. Induction of core elements was evaluated by analysis of change in immediate affective responses and by computerized text analysis of word use. RESULTS: Feasibility criteria were successfully met. The disclosure condition produced higher immediate negative affect and use of emotion, insight, and optimism words compared to control, and induced the elements of change within sessions as intended. CONCLUSION: The adapted intervention is feasible for home application and induces change in variables that indicate emotional engagement, cognitive restructuring, and positive future directedness. PRACTICE IMPLICATIONS: Empirical support of health benefits of this emotional disclosure intervention will extend its applicability in patient self-care.
19052835 Necrotising scleritis and connective tissue disease--three cases and a review. 2009 Mar Necrotising scleritis is a severe form of anterior scleritis which is known to be associated with connective tissue disease but has not previously been reported in association with limited scleroderma. It is often a difficult condition to treat and without adequate early intervention leads to significant morbidity including visual loss. We report three cases of necrotising scleritis, two occurring in the context of previously unreported associations and a third case to compare presentation of the condition and highlight difficulties in management.
18212480 Effects of melittin on the production of matrix metalloproteinase-1 and -3 in rheumatoid a 2008 Jan Bee venom (BV) has been used in patients with rheumatoid arthritis, a condition characterized by rheumatoid joint destruction mediated, in large part, by matrix metalloproteinases (MMPs). We investigated the effects of melittin, a major component of bee venom, on the production of MMPs in human rheumatoid arthritic fibroblast-like synoviocytes (FLS). Lipopolysaccharide (LPS)-stimulated MMP3 production was significantly inhibited by melittin, which also inhibited LPS-induced DNA binding by nuclear factor kappaB (NF-kappaB). Mellitin had no effect on IL-1beta- or TNF-alpha-induced MMP1 or MMP3 production and did not decrease LPS-induced secretion of MMP1. Taken together, these findings suggest that melittin may exert its anti-rheumatoid effects, at least in part, by inhibiting MMP3 production, most likely through inhibition of NF-kappaB activity.
17344343 Use of serum or buffer-changed EDTA-plasma in a rapid, inexpensive, and easy-to-perform he 2007 May We previously described a simplified quantitative hemolytic assay for classical pathway (CP) hemolytic function in serum that has been shown to correlate with the 50% hemolytic complement (CH50) assay. In the present study, we used this assay to compare CP functions; plasma levels of C3, C4, and C3dg; and ratios of C3dg to C3 in healthy individuals and patients with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA) with different degrees of complement activation. A significant depression in CP function and levels of C4 and C3 and increased C3dg levels and C3dg/C3 ratios were observed in the SLE patients. In patients with RA, CP function was normal, whereas C3, C4, and C3dg levels and the C3dg/C3 ratio were elevated. The SLE results are compatible with systemic complement consumption, whereas the RA data suggest an acute-phase reaction with a normal C3 catabolic rate. To facilitate the handling of patient samples, we also developed a method to restore the hemolytic function of EDTA-plasma by transferring it to Veronal-buffered saline containing the thrombin inhibitor lepirudin. This process inhibits coagulation and enables complement activation, allowing a longer time lag between sample harvesting and testing. These results, combined with previous correlation studies, suggest that the CP hemolytic assay can effectively replace the CH50 assay for routine SLE differential diagnosis and monitoring of disease activity.
17334734 [Basic treatment of early rheumatoid arthritis. Abstaining from rheumatological care and p 2007 Mar The major challenge in the management of rheumatoid arthritis (RA) is the early initiation and long-term continuation of disease-modifying antirheumatic drug (DMARD) therapy. A total of 916 RA patients (ACR criteria, disease duration <2 years) were investigated in regard to frequency and reasons for DMARD discontinuation. All patients were under rheumatological care at the start of the observation and almost all were receiving DMARDs at study entry (95%). The proportion decreased to 87% within 3 years. Of the 171 patients without DMARD, 5% abstained due to (planned) pregnancy, 28% due to contraindications and/or severe adverse events and 54% due to remission. Only 12% were non-compliant. Multivariate regression analysis revealed non-specialised care (OR 4.6; 59% CI 3.2-6.7), RF seronegativity (OR 2.6; 95% CI 1.8-3.8), no patient education (OR 2.2; CI 95% 1.5-3.4), preference for alternative medicine (OR 8.2; 95% CI 4.0-16.8) and > or =10 years of education (OR 1.8; 95% CI 1.3-2.7) as independent risks for DMARD abstention. Age, sex, comorbidity or disease activity did not influence adherence to DMARD therapy. Since preference for alternative medicine was the strongest risk predictor, further investigations are needed to determine the characteristics of this preference regarding compliance with DMARD medication in RA. The positive influence of patient education on DMARD continuation emphasizes its importance.
16828289 Flexion after total knee replacement. A comparison between the Medial Pivot knee and a pos 2006 Oct A comparison was made between 261 knees replaced with the Medial Pivot arthroplasty and 288 replaced with the 913 posterior stabilised arthroplasty (PS knee). There was no significant difference in the flexion obtained at 12 months after surgery (111 degrees and 109 degrees , respectively). When the knees were grouped into preoperative flexion ranges, there was no significant difference between the two implants. Those knees with preoperative flexion up to 90 degrees gained most (mean 22.6 degrees and 19 degrees for the PS knee and Medial Pivot, respectively). Knees with a preoperative flexion of 125 degrees or greater lost flexion. Regression analysis of individual knees revealed a small (average 2.9 degrees ), but significant greater loss of flexion at 12 months after surgery in the Medial Pivot group, with increasing preoperative flexion (beta coefficient = 2.923, P = 0.007). Some knees in both groups which had less than average preoperative flexion lost rather than gained flexion. We attributed this to patient factors such as pain, swelling and poor compliance with rehabilitation. Although the Medial Pivot knee may have advantages in terms of contact area and kinematics we found no advantage in terms of postoperative flexion over our posterior stabilised knee.
18754751 Drug delivery systems for the treatment of rheumatoid arthritis. 2008 Sep Rheumatoid arthritis (RA) is a severe immune-mediated disease characterized by chronically progressive inflammation and destruction of joints and associated structures. Significant advances in our understanding of its pathophysiology and early diagnosis have led to improved therapy and better outcome. Nevertheless, a number of details in the pathogenesis of RA are still unknown and thus the disease cannot be cured at present. Therefore, current therapy aims at accomplishing complete and long-lasting remission. However, this goal is only achieved in a small proportion of patients, and partial remission and frequent relapses are a common problem. A significant number of patients still do not respond at all to available treatments. In addition, all antirheumatic and immune-modulating drugs developed so far carry a considerable risk of adverse effects, some of which can be severe or even life threatening. This is due, at least in part, to a lack of specificity of most drugs for the target tissue, and to a high volume of distribution for systemic application, which, together with rapid clearance of most drugs, requires frequent application of high dosages. Targeted drug delivery and prolongation of bioavailability would alleviate this issue significantly. This article, therefore, reviews a selection of studies that report promising strategies for joint specific delivery of antiarthritic drugs.