Pharmacotherapy of rheumatoid arthritis: a narrative review

Abstract

Purpose: This review summarizes the mechanisms of action, safety profiles, and monitoring strategies of the major pharmacological agents currently used to treat rheumatoid arthritis (RA) in Korea.Current concepts: RA is a chronic systemic autoimmune disease characterized by persistent synovial inflammation that can lead to progressive joint destruction, functional impairment, and reduced quality of life. The primary treatment goal is remission or low disease activity, and regular disease activity assessment within a treat-to-target strategy has become an international standard. Disease-modifying antirheumatic drugs (DMARDs) are the cornerstone of RA pharmacotherapy and are classified as conventional synthetic DMARDs (csDMARDs), biologic DMARDs, or targeted synthetic DMARDs. Methotrexate-based csDMARD therapy remains the usual starting point, whereas the introduction of multiple biologic agents and Janus kinase inhibitors has expanded treatment options. In addition, the broad availability of biosimilars for major biologic agents has improved treatment accessibility.Discussion and conclusion: Drug selection should account for patient characteristics and comorbidities. The identification of biomarkers that predict response to specific DMARDs, together with long-term pharmacoepidemiological data in Korean patients, will be important for advancing precision medicine in RA.