A new era in the treatment of immune-mediated inflammatory disorders has begun with the clinical availability of anticytokine therapy. Biological agents that are currently available include 3 agents that decrease the activity of tumor necrosis factor-α (infliximab, adalimumab, etanercept) and an interleukin-1 receptor antagonist (anakinra), with many more in development. Those extraordinarily effective medications are an important addition to our therapeutic armamentarium, and, although originally developed for rheumatoid arthritis and Crohn disease, have been found to be efficacious in the treatment of seronegative spondyloarthropathies (psoriatic arthritis, ankylosing spondylitis) and juvenile rheumatoid arthritis. Their role is currently being defined in other autoimmune disorders such as uveitis, sarcoidosis, interstitial lung disease, vasculitis, inflammatory myopathies, graft-versus-host disease, and Sjögren syndrome.
* The treatment of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and other immune-mediated inflammatory disorders has been revolutionized by the introduction of the biological agents.
* Tumor necrosis factor-α–blocking and interleukin-1–blocking agents can efficiently eliminate symptoms, prevent structural damage, and greatly improve the patient's quality of life.
* Close monitoring by experienced physicians is warranted, as these medications have been associated with rare but serious side effects.
* The high cost of these agents must be balanced against the direct and indirect costs that rheumatoid arthritis and its effects have on the individual patient and society.