Clinical Immunotherapeutics

, Volume 5, Issue 4, pp 309–325 | Cite as

The Use of Slower-Acting (Class III) Symptom-Modifying Antirheumatic Drugs in Rheumatoid Arthritis

  • William S. Wilke
  • Joseph M. Cash
Review Article Treatment Review


Slower-acting (class III) symptom-modifying drugs are given in rheumatoid arthritis to control acute signs and symptoms of the disease, with the hope of favourably modifying long term outcome.

Among these agents, methotrexate, sulfasalazine and hydroxychloroquine offer the best efficacy/toxicity ratio. Unfortunately, sustained remission with treatment is rare, and most analyses demonstrate long term progressive disability. Clearly, strategies that initiate single-agent therapy with the currently available class III symptom-modifying drugs only after failure of physical therapy and treatment with nonsteroidal anti-inflammatory drugs are successful in only a small proportion of patients. For most patients with moderate to severe disease at the time of diagnosis, this approach should probably be abandoned. New agents and/or new strategies are needed.

Newer biological agents have not proven superior to existing therapies, nor are they readily available to most practising clinicians. However, novel strategies using existing agents can often control disease in the short term and might also offer improved long term outcome. There is reason to believe that both of these goals can be met by using a strategy in which sufficiently aggressive treatment is given to decrease the number of swollen joints to ≤5 and to normalise acute phase reactant levels. If combinations of class III symptom-modifying drugs are necessary to achieve these goals, methotrexate combined with hydroxychloroquine, sulfasalazine or cyclosporin seem the best choices today.


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Copyright information

© Adis International Limited 1996

Authors and Affiliations

  • William S. Wilke
    • 1
  • Joseph M. Cash
    • 1
  1. 1.Department of Rheumatic and Immunologic DiseasesCleveland Clinic FoundationClevelandUSA

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