Rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation of the joints. The disease affects 0.5% to 1% of the adult population, and causes severe pain and disability. Direct costs related to treatment, and indirect costs associated with occupational disability, is significant. RA is treated with an interdisciplinary approach, in which disease modifying anti-rheumatic drugs (DMARDs) are an important component. The recommended first choice is one or more DMARDs. In the absence of treatment effect, a biologic drug may be added.

The purpose of this systematic review was to investigate the efficacy and safety of biologics, compared with DMARDs in patients with early (≤ 3 years) RA. The commisioner is the Norwegian Rheumatism Association, whose members are concerned with good treatment at the early stages of RA.

We included a total of 12 randomised controlled trials that examined the effect of biologics infliximab, adalimumab, etanercept and abatacept. The results suggest that, compared with DMARDs alone, biologicals in combination with DMARDs give:

• more patients in remission
• neither more or less serious adverse events
• more patients who achieved a 50% improvement
• improved physical function
• less joint destruction

Due to methodological weaknesses in the included studies most results contain some degree of uncertainty.