L’amélioration très importante des connaissances sur la pathogénie des rhumatismes inflammatoires au cours des vingt dernières années et l’identification de cibles précises impliquées dans l’inflammation articulaire, a permis de développer des thérapeutiques ciblées pour le moment essentiellement d’origine biologique. Les anti-TNF ont été les premières biothérapies disponibles dans la polyarthrite rhumatoïde puis dans la spondy- larthrite et le rhumatisme psoriasique. Secondairement, un anticorps anti-CD20 du lym- phocyte B, (rituximab), l’abatacept, inhibiteur des voies de co-stimulation CD28-CD80/86 du lymphocyte T, et le tocilizumab, inhibiteur du récepteur de l’interleukine-6 ont été également autorisés dans la polyarthrite rhumatoïde. Ces biothérapies ont transformé la prise en charge et l’évolution à moyen et long terme des patients atteints de polyarthrite rhumatoïde et de spondyloarthrite. Les stratégies thérapeutiques des patients sont actuel- lement bien définies en fonction des critères d’activité et de sévérité de la maladie. Les sociétés internationales comme l’EULAR et l’ASAS ont émis des recommandations de stratégies précises et utiles pour la pratique courante.

Major advances in our knowledge of the pathogenesis of inflammatory arthritis during the last 20years, including the identification of precise targets of joint inflammation, led to the development of biologic targeted therapies. TNF inhibitors were the first such agents to be approved in rheumatoid arthritis, followed by ankylosing spondylitis and psoriatic arthritis. Later, rituximab, an anti-CD20 B lymphocyte antibody; abatacept, which inhibits the T cell co-stimulatory CD28-CD80 pathway; and tocilizumab, an interleukin-6 receptor inhibitor, were launched in rheumatoid arthritis. These biologics have dramatically changed the management and mid- to long-term outcomes of patients with rheumatoid arthritis and spondyloarthritis. Current therapeutic strategies are based on disease activity and severity. International societies such as EULAR and ASAS have published precise recommendations for routine management of these patients. Major advances in our knowledge of the pathogenesis of inflammatory arthritis during the last 20years, including the identification of precise targets of joint inflammation, led to the development of biologic targeted therapies. TNF inhibitors were the first such agents to be approved in rheumatoid arthritis, followed by ankylosing spondylitis and psoriatic arthritis. Later, rituximab, an anti-CD20 B lymphocyte antibody; abatacept, which inhibits the T cell co-stimulatory CD28-CD80 pathway; and tocilizumab, an interleukin-6 receptor inhibitor, were launched in rheumatoid arthritis. These biologics have dramatically changed the management and mid- to long-term outcomes of patients with rheumatoid arthritis and spondyloarthritis. Current therapeutic strategies are based on disease activity and severity. International societies such as EULAR and ASAS have published precise recommendations for routine management of these patients.