Progress in rheumatology in the early 21 <sup>st</sup> century
Rheumatoid arthritis (RA), juvenile arthritis, spondyloarthritis, including psoriatic arthritis, systemic lupus erythematosus (SLE), and other systemic connective tissue diseases, are the most severe chronic immunoinflammatory rheumatic diseases (IIRDs) that affect as high as 10% of the population. Substantial progress has been made in the treatment of IIRDs in the 21 st century. The current Treat to Target (T2T) strategy for RA is to achieve remission as soon as possible. The main treatment goal is to improve quality of life, by controlling the symptoms of the disease, by preventing joint destruction and dysfunction, and by maintaining social possibilities. The most important way to achieve this goal is to inhibit inflammation and to evaluate the efficiency of treatment, by using the standardized activity indices and by choosing the appropriate treatment option. The widespread use of biological agents in combination with standard disease-modifying antirheumatic drugs could substantially enhance therapeutic effectiveness. A new class of medicaments (chemically synthesized small molecular weight agents) to treat RA has appeared. The point of their application is tyrosine kinases, primarily Janus kinase (JAK). The new era in the treatment of SLE and other IIRDs is associated with the design of the new class of drugs - BLyS inhibitors. In the coming years, the main lines of researches by Russian rheumatologists will be to elaborate a strategy to prevent IIRDs; to introduce innovative methods for their early diagnosis and treatment (biological agents, JAK inhibitors, and other cell signaling molecules) and for the prediction of the outcomes of the most severe forms of IIRD; to realize the concept of personified medicine (to investigate the prognostic biomarkers of the efficiency and safety of targeted therapy), to reduce the risk of infectious complications, cardiovascular diseases, cancer, osteoporotic fractures, and other comorbidities.