Summary
Disease-modifying antirheumatic drugs (DMARDS) have been used in the treatment of rheumatoid arthritis for a number of years. Despite this extensive use, their efficacy in modifying the course of the disease has been disputed. Possible reasons for this might be the design of the relevant studies, the fact that patients were studied in a late phase of their disease, and the methods used to evaluate radiographic progression.
With the use of drugs such as methotrexate and sulfasalazine early in the disease process a retardation of radiographic progression has been clearly demonstrated. Another advantage of these drugs is their relatively rapid onset of action and improved risk-benefit ratio compared with older drugs.
Whether treatment with combinations of DMARDs is superior to treatment with single agents is the subject of ongoing studies.
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References
Harris ED Jr. Rheumatoid arthritis: pathophysiology and implications for therapy. N Engl J Med 1990; 322: 1277–89
Brooks PM, Day RO. Drug therapy: nonsteroidal antiinflammatory drugs — differences and similarities. N Engl J Med 1991; 324: 1716–25
Capell HA, Brzeski M. Slow drugs: slow progress? Use of slow acting antirheumatic drugs (SAARDs) in rheumatoid arthritis. Ann Rheum Dis 1992; 51: 424–9
Edmonds J. Reclassification of antirheumatic agents: how and why. Clin Immunother 1994; 1: 110–6
Scott DL, Huskisson EC. The course of rheumatoid arthritis. Baillieres Clin Rheumatol 1992; 6: 1–21
Fries JF. Toward an understanding of patient outcome measurement. Arthritis Rheum 1983; 26: 697–704
Meenan RF, Gertman PM, Mason JH, et al. The arthritis impact measurement scales. Arthritis Rheum 1982; 25: 1048–53
Jeurissen MEC, Boerbooms AMT, van de Putte LBA, et al. Influence of methotrexate and azathioprine on radiologic progression in rheumatoid arthritis: a randomized double-blind study. Ann Intern Med 1991; 114: 999–1004
van der Heijde DM, van Riel PL, Nuver-Zwart HH, et al. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet 1989; 1: 1036–8
van der Heijde DMFM, van Riel PLCM, Nuver-Zwart HH, et al. Sulphasalazine versus hydroxychloroquine in rheumatoid arthritis: 3 year follow-up [letter]. Lancet 1990; 335: 539
Fries JF, Williams C, Ramey D, et al. The relative toxicity of disease modifying anti-rheumatic drugs. Arthritis Rheum 1993; 36: 297–306
Wolfe F, Hawley D, Cathey M. Termination of slow acting antirheumatic therapy in rheumatoid arthritis: a 14 year-prospective evaluation of 1017 starts. J Rheumatol 1990; 17: 994–1002
van der Heijde DMFM, van Leeuwen MA, van Riel PLCM, et al. Biannual radiographic assessments of hands and feet in a three-year prospective followup of patients with early rheumatoid arthritis. Arthritis Rheum 1992; 35: 26–34
van der Heijde DM, van Riel PL, Nuver-Zwart HH, et al. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet 1989; 1: 1036–8
Pincus T, Callahan LF. Rheumatology function tests: grip strength, walking time, button test and questionnaires document and predict longterm morbidity and mortality in rheumatoid arthritis. J Rheumatol 1992; 19: 1051–7
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van de Putte, L.B.A., van Riel, P.L.C.M. Do Disease-Modifying Antirheumatic Drugs Actually Modify Disease Course in Rheumatoid Arthritis?. Clin. Immunother. 1, 319–322 (1994). https://doi.org/10.1007/BF03258509
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DOI: https://doi.org/10.1007/BF03258509