The Medical journal of Australia
-
There are now eight approved biological disease-modifying antirheumatic drugs (bDMARDs), two biosimilars and one targeted synthetic DMARD in Australia with a number of new products and biosimilars in the pipeline. bDMARDs have excellent efficacy, especially when combined with traditional DMARDs, and a well characterised but manageable safety profile. These expanded therapeutic options have revolutionised patient care and made remission (including drug free remission) a realistic goal. Evidence of a "window of opportunity" that changes the long term phenotype of the disease has been well established, so therapy should be commenced as early as possible in the disease process and a shared care model between general practitioner and rheumatologist provides the best outcomes. While there is no cure for rheumatoid arthritis, treatment has improved to the point where many patients can achieve a normal quality of life.
-
Rheumatic diseases are frequently complicated by extra-articular manifestations, often affecting the eye. Most of these ocular symptoms are benign and develop over long periods of time. ⋯ It is vital that sight-threatening complications are recognised quickly, so that appropriate diagnostic and therapeutic procedures, such as slit lamp examination and the initiation of immunosuppressive treatments, can occur in a timely fashion. Insight into the epidemiology, clinical presentation, common complications and treatment regimens of these ocular manifestations enables early detection and may prevent permanent loss of vision.
-
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease predominantly affecting women of childbearing age. New classification criteria for SLE have greater sensitivity and therefore improve the diagnostic certainty for some patients, especially those who may previously have been labelled as having undifferentiated symptoms. ⋯ The development of biological therapy lags behind that for other rheumatic diseases, with belimumab being the only targeted therapy approved by the Therapeutic Goods Administration. "Treat-to-target" concepts are changing trial design and clinical practice, with evidence-based definition of response criteria in the form of remission and low disease activity now on the horizon. While new therapies are awaited, research should also focus on optimising the use of current therapy and improving the quality of care of patients with SLE.