Therapeutic Drug-Monitoring of Methotrexate-Polyglutamates in Rheumatoid Arthritis

Abstract

Rheumatoid Arthritis (RA) is a chronic autoimmune disease, characterized by the swelling of joints, uncontrolled proliferation of synovial tissue and multisystem co-morbidities. RA mainly affects the joints of the hands, feet, knees, wrist and elbows, with joint damage occurring early in the disease course. RA affects an estimated 1% of the general population and women have a higher risk of developing RA than men. Despite the fact that treatment strategy has changed considerably over the years, reflected by a much improved disease outcome, there is still no cure for RA. Early initiation of therapy is effective in prevention of joint damage and results in milder medication regimes while maintaining disease remission. Early in the disease, the inflammation is less self-perpetuating and easier to suppress, therefore it is important to start treatment as early as possible in order to optimize outcome, minimize medical costs, improve quality of life, and improve medical decision making.