Skip to main content
SpringerLink
Log in

The Optimum Management of Arthropathies

  • Practical Therapeutics
  • Published:
Drugs Aims and scope Submit manuscript

Summary

The aims in management of an arthropathy are to relieve symptoms, preserve function, and control the disease process. Drugs are an important, although not the only, part of any therapeutic regimen enabling us to achieve these aims.

Although each individual requires a unique strategy, there is a logical progression from first-line agents to second-line agents. Third-line agents and experimental methods are reserved for aggressive or life-threatening disease. The choice of agent in each group is personal preference, but many agents have high adverse effect profiles, and close moni-toring is essential.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Anon. Fish oils in rheumatoid arthritis. Lancet 2: 720–721, 1987

  • Ansell BM, Hall MA, Ribero S. A comparative study of gold and penicillamine in seropositive juvenile chronic arthritis. Abstract. Annals of the Rheumatic Diseases 40: 522–523, 1981

    Google Scholar 

  • Belch JJF, Madhok R, McArdler B, McLaughlin K, Kluft C, et al. The effect of increasing fibrinolysis in patients with rheumatoid arthritis: a double-blind study of stanozolol. Quarterly Journal of Medicine 58: 19–27, 1986

    PubMed  CAS  Google Scholar 

  • Bhatt-Sanders D. Acupuncture for rheumatoid arthritis: analysis of the literature. Seminars in Arthritis and Rheumatism 14: 225–231, 1985

    Article  PubMed  CAS  Google Scholar 

  • Bird HA, Ring EFJ, Bacon PA. A thermographic and clinical comparison of three intra-articular steroid preparations in rheumatoid arthritis. Annals of the Rheumatic Diseases 38: 36–39, 1979

    Article  PubMed  CAS  Google Scholar 

  • Bird HA, Wright V. Applied drug therapy of the rheumatic diseases, John Wright, Bristol, 1982

    Google Scholar 

  • Boers M, Van Rijthoven AWAM, Goei The HS, Dijkmans BAC, Cats A. Serum creatinine levels two years later: follow-up of a placebocontrolled trial of cyclosporin in rheumatoid arthritis. Abstract. British Journal of Rheumatology 26 (Suppl. 2): 3, 1987

    Google Scholar 

  • Bunch TW, O’Duffy JD. Disease-modifying drugs for progressive rheumatoid arthritis. Mayo Clinic Proceedings 55: 161–179, 1980

    PubMed  CAS  Google Scholar 

  • Bunch TW, O’Duffy JD, Tompkins RB, O’Fallon WM. Controlled trial of hydroxychloroquine and D-penicillamine singly and in combination in the treatment of rheumatoid arthritis. Arthritis and Rheumatism 27: 267–276, 1984

    Article  PubMed  CAS  Google Scholar 

  • Byron MA, Kirwan JR. Corticosteroids in rheumatoid arthritis: is a trial of their disease-modifying potential feasible? Annals of the Rheumatic Diseases 46: 171–173, 1986

    Article  Google Scholar 

  • Cannon GW, Jackson CG, Samuelson CO, Ward JR, Williams HJ, et al. Chlorambucil therapy in rheumatoid arthritis: clinical experience in 28 patients and literature review. Seminars in Arthritis and Rheumatism 15: 106–118, 1985

    Article  PubMed  CAS  Google Scholar 

  • Chaffman M, Brogden RN, Heel RC, Speight TM, Avery GS. Auranofin: a preliminary review of its pharmacological properties and therapeutic use in rheumatoid arthritis. Drugs 27: 378–424, 1984

    Article  PubMed  CAS  Google Scholar 

  • Cooperating Clinics Committee of the American Rheumatism Association. A controlled trial of cyclophosphamide in rheumatoid arthritis. New England Journal of Medicine 283: 833–889, 1970

    Google Scholar 

  • Cooperating Clinics Committee of the American Rheumatism Association. A controlled trial of gold salt therapy in rheumatoid arthritis. Arthritis and Rheumatism 16: 353–358, 1973

    Article  Google Scholar 

  • Currey HLF, Harris J, Mason RM. Comparison of azathioprine, cyclophosphamide and gold in the treatment of rheumatoid arthritis. British Medical Journal 3: 763–766, 1974

    Article  PubMed  CAS  Google Scholar 

  • Dodd MJ, Griffiths ID, Thompson M. Adverse reactions to D-penicillamine after gold toxicity. British Medical Journal 280: 1498–1500, 1980

    Article  PubMed  CAS  Google Scholar 

  • Dorwart BB, Gall EP, Schumacher HR, Krauser RE. Crysotherapy in psoriatic arthropathy: efficacy and toxicity compared to rheumatoid arthritis. Arthritis and Rheumatism 21: 573–575, 1978

    Article  Google Scholar 

  • Dwosh IL, Stein HB, Urowitz MB, Smythe HA, Hunter T, et al. Azathioprine in early rheumatoid arthritis: comparison with gold and chloroquine. Arthritis and Rheumatism 20: 685–692, 1977

    Article  PubMed  CAS  Google Scholar 

  • Emery P, Gibson T. A double-blind study of the simple analgesic nefopam in rheumatoid arthritis. British Journal of Rheumatology 25: 72–76, 1986

    Article  PubMed  CAS  Google Scholar 

  • European League against Rheumatism. Proceedings of the International Symposium on Levamisole in Rheumatoid Arthritis, Antwerp, June 23, 1978. Journal of Rheumatology 5 (Suppl. 4), 1978

  • Fike MC. How occupational therapy can help your arthritis patient. Journal of Musculoskeletal Medicine 1: 51–58, 1984

    Google Scholar 

  • Ford PM. HLA antigens and drug toxicity in rheumatoid arthritis. Journal of Rheumatology 11: 259–261, 1984

    PubMed  CAS  Google Scholar 

  • Furst DE. Mechanism of action, pharmacology, clinical efficacy and side-effects of auranofin: an orally administered gold compound for the treatment of rheumatoid arthritis. Pharmacotherapy 3: 284–298, 1983

    PubMed  CAS  Google Scholar 

  • Grindulis KA, Nichol FE, Oldham R. Phenytoin in rheumatoid arthritis. Journal of Rheumatology 13: 1035–1039, 1986

    PubMed  CAS  Google Scholar 

  • Hall CL, Jawad S, Morrison PR, MacKenzie JC, Bacon PA, et al. Natural course of penicillamine nephropathy: a long term study of 33 patients. British Medical Journal 296: 1083–1086, 1988

    Article  PubMed  CAS  Google Scholar 

  • Hall ND, Bird HA, Ring EFJ, Bacon PA. A combined clinical and immunological assessment of four cyclophosphamide regimes in rheumatoid arthritis. Agents and Actions 9: 97–102, 1979

    Article  PubMed  CAS  Google Scholar 

  • Hanly JG, Hasson J, Mariarly M, Barry C, Molony J, et al. Lymphoid irradiation in intractable rheumatoid arthritis. Arthritis and Rheumatism 29: 16–25, 1986

    Article  PubMed  CAS  Google Scholar 

  • Hobbs HE, Sarsby A, Freeman A. Retinopathy following chloroquine therapy. Lancet 2: 478–480, 1959

    Article  PubMed  CAS  Google Scholar 

  • Hunter T, Urowitz MB, Gordon DA, Smythe HA, Ogryzlo MA. Azathioprine in arthritis: a long-term follow-up study. Arthritis and Rheumatism 18: 15–20, 1975

    Article  PubMed  CAS  Google Scholar 

  • Huskisson EC. Antirheumatic drugs. Clinics in Rheumatic Diseases 5: 357–736, 1979

    Google Scholar 

  • Huskisson EC, Doyle DV, Lanham JG. Drug treatment of osteoarthritis. Clinics in Rheumatic Diseases 11: 421–431, 1985

    PubMed  CAS  Google Scholar 

  • Joint Committee of the Medical Research Council and the Nuffield Foundation. A comparison of prednisolone with aspirin or other analgesics in the treatment of rheumatoid arthritis. Annals of the Rheumatic Diseases 18: 173–187, 1959

    Article  Google Scholar 

  • Joint Committee of the Medical Research Council and the Nuffield Foundation. A comparison of prednisolone with aspirin or other analgesics in the treatment of rheumatoid arthritis. Annals of the Rheumatic Diseases 19: 331–337, 1960

    Article  Google Scholar 

  • Karsh J, Klippel JH, Plotz PH, Wright DG, Flye W, et al. Lymphoparesis in rheumatoid arthritis: a randomised trial. Arthritis and Rheumatism 23: 701–702, 1980

    Google Scholar 

  • Karsh J, Wright DG, Klippel JH, Decber JL, Deisseroth AB, et al. Lymphocyte depletion by continuous flow centrifugation in rheumatoid arthritis. Arthritis and Rheumatism 22: 1055–1059, 1979

    Article  PubMed  CAS  Google Scholar 

  • Lunkkainen R, Isonaki H, Kojarder A. Effect of gold treatment on the progression of erosions in rheumatoid arthritis patients. Scandinavian Journal of Rheumatology 6: 123–127, 1977

    Article  Google Scholar 

  • Malaise MG, Hauwaert C, Franchimont P, Danncskidd-Semsoe B, Bach-Anderson R, et al. Treatment of active rheumatoid arthritis with slow intravenous injections of thymopentin. Lancet 1: 832–836, 1985

    Article  PubMed  CAS  Google Scholar 

  • Martin MFR, Surrall KE, McKenna F, Dixon JS, Bird HA, et al. Captopril: a potential new treatment for rheumatoid arthritis. Lancet 1: 1325–1327, 1984

    Article  PubMed  CAS  Google Scholar 

  • Mason RM, Currey HLF, Barnes CG. Azathioprine in rheumatoid arthritis. British Medical Journal 1: 420–421, 1969

    Article  PubMed  CAS  Google Scholar 

  • Mattingly S. Palindromic Rheumatism. Annals of the Rheumatic Diseases 25: 307–316, 1966

    PubMed  CAS  Google Scholar 

  • Multicentre Trial Group. Controlled trial of D-penicillamine in severe rheumatoid arthritis. Lancet 1: 275–280, 1973

    Article  Google Scholar 

  • Multicentre Study Group. Levamisole in rheumatoid arthritis. Lancet 2: 1007–1012, 1978

    Article  Google Scholar 

  • Nacarro AH. Physical therapy in the management of rheumatoid arthritis. Clinical Rheumatology 1: 125–130, 1983

    Google Scholar 

  • Needs CJ, Brooks P. Anti-rheumatic medication in pregnancy. British Journal of Rheumatology 24: 282–290, 1985

    Article  PubMed  CAS  Google Scholar 

  • Nelson AM, Carn DL. Glucocorticoids in rheumatic disease. Mayo Clinic Proceedings 55: 758–769, 1980

    PubMed  CAS  Google Scholar 

  • Neumann VC, Grindulis KA, Hubball S, McCankey B, Wright V. Comparison between penicillamine and sulphasalazine in rheumatoid arthritis: Leeds-Birmingham trial, British Medical Journal 287: 1099–1102, 1983

    Article  PubMed  CAS  Google Scholar 

  • Neumann V, Hopkins R, Dixon J, Walkins A, Bird H, et al. Combination therapy with pulsed methylprednisolbne in rheumatoid arthritis. Annals of the Rheumatic Diseases 44: 747–757, 1985

    Article  PubMed  CAS  Google Scholar 

  • Owen ET, Cohen ML. Methotrexate in Reiter’s disease. Annals of the Rheumatic Diseases 38: 48–50, 1979

    Article  PubMed  CAS  Google Scholar 

  • Panayi GS, Wooley P, Batchelor JR. Genetic basis of rheumatoid disease: HLA antigens, disease manifestations, and toxic reactions to drugs. British Medical Journal 2: 1326–1328, 1978

    Article  PubMed  CAS  Google Scholar 

  • Paulus HE, Macheder HI, Levine S, Yu DTY, MacDonald NS. Lymphocytic involvement in rheumatoid arthritis: studies during thoracic duct drainage. Arthritis and Rheumatism 20: 1249–1262, 1977

    Article  PubMed  CAS  Google Scholar 

  • Proceedings. Advances in arthritis therapy: experience with methotrexate, Anaheim, June 8, 1985. Journal of Rheumatology 12 (Suppl. 12), 1985

  • Pullar T, Hunter JA, Capell HA. Sulphasalazine in rheumatoid arthritis: a double-blind comparison of sulphasalazine with placebo and sodium aurothiomalate. British Medical Journal 287: 1102–1104, 1983

    Article  PubMed  CAS  Google Scholar 

  • Rainsford K. Side effects of anti-inflammatory/analgesic drugs: epidemiology and gastrointestinal tract. Trends in Pharmacological Sciences, April 1–4, 1984

  • Research Sub-Committee of the Empire Rheumatism Council. Gold therapy in rheumatoid arthritis: final report of a multicentre controlled trial. Annals of the Rheumatic Diseases 20: 315–334, 1961

    Article  Google Scholar 

  • Richter MB, Kinsella P, Corbett M. Gold in psoriatic arthropathy. Annals of the Rheumatic Diseases 39: 279–280, 1980

    Article  PubMed  CAS  Google Scholar 

  • Rotherwell RS, Davies P, Gardon PA, Dasgupta MK, Johny KV, et al. A controlled study of plasma exchange in the treatment of severe rheumatoid arthritis. Arthritis and Rheumatism 23: 785–790, 1980

    Article  Google Scholar 

  • Rynes RI. Antimalarial treatment of rheumatoid arthritis. Journal of Rheumatology 12: 657–659, 1985

    PubMed  CAS  Google Scholar 

  • Rynes RI, Krohel G, Falbo A, Reuniecke RD, Wolfe B, et al. Ophthamological safety of long-term hydroxychloroquine treatment. Arthritis and Rheumatism 22: 832–836, 1979

    Article  PubMed  CAS  Google Scholar 

  • Sheppeard H, Ward DJ. Intra-articular osmic acid in rheumatoid arthritis: five years experience. Rheumatology and Rehabilitation 19: 25–29, 1980

    Article  PubMed  CAS  Google Scholar 

  • Sigler JW, Bluhm GB, Duncan H, Sharp JT, Ensign DC, et al. Gold salts in the treatment of rheumatoid arthritis: a double-blind study. Annals of Internal Medicine 80: 21–26, 1974

    PubMed  CAS  Google Scholar 

  • Simon LS, Mills JA. Non-steroidal anti-inflammatory drugs. Part 1. New England Journal of Medicine 302: 1179–1188, 1980

    Article  PubMed  CAS  Google Scholar 

  • Smyth CJ, Bartholomew BA, Mills BM. Cyclophosphamide therapy for rheumatoid arthritis. Archives of Internal Medicine 135: 789–793, 1975

    Article  PubMed  CAS  Google Scholar 

  • Spalton D. Chloroquine and the eye. British Journal of Clinical Practice 41 (Suppl. 52): 50–55, 1987

    Google Scholar 

  • Symoens J, Schuermans Y. Levamisole. Clinics in Rheumatic Diseases 5: 603–629, 1979

    Google Scholar 

  • Symposium on Radioactive Colloids in the Treatment of Arthritis. Annals of the Rheumatic Diseases 32 (Suppl.), 1973

  • Trentham DE, Belli JA, Anderson RJ, Buckley JA, Goetzl EJ, et al. Clinical irradiation in refractory rheumatoid arthritis. New England Journal of Medicine 305: 976–982, 1981

    Article  PubMed  CAS  Google Scholar 

  • Tugwell P, Bennett K, Gent M. Methotrexate in rheumatoid arthritis. Annals of Internal Medicine 107: 358–366, 1987

    PubMed  CAS  Google Scholar 

  • Van Rijthoven AWAM, Dijkmans BAC, Goei The HS, Hemans J, Montrar-Beckers ZLMB, et al. Cyclosporin treatment for rheumatoid arthritis: a placebo-controlled, double-blind multicentre study. Annals of the Rheumatic Diseases 45: 726–731, 1986

    Article  PubMed  Google Scholar 

  • Veo T, Taraba S, Taminaga Y, Ogana H, Schwarmi T. The effect of thoracic duct drainage in lymphocyte dynamics and clinical symptoms in patients with rheumatoid arthritis. Arthritis and Rheumatism 22: 1405–1412, 1979

    Article  Google Scholar 

  • Wallace DJ, Goldfinger D, Galti R, Lowe C, Fan P, et al. Plasmapheresis and lymphoplasmapheresis in the management of rheumatoid arthritis. Arthritis and Rheumatism 22: 703–710, 1979

    Article  PubMed  CAS  Google Scholar 

  • Weinblatt ME, Coblyn JS, Fox DA, Fraser PA, Holdsworth DE, et al. Efficacy of low-dose methotrexate in rheumatoid arthritis. New England Journal of Medicine 312: 818–820, 1985

    Article  PubMed  CAS  Google Scholar 

  • Wilkins RF, Williams HJ, Ward JR. Egger MJ, Reading JC, et al. Randomised double-blind placebo-controlled trial of low dose pulse methotrexate in psoriatic arthritis. Arthritis and Rheumatism 27: 376–381, 1984

    Article  Google Scholar 

  • Williams HJ, Wilkins RF, Samuelson CO, Alarcon GS, Guttadauria M, et al. Comparison of low dose oral pulse methotrexate and placebo in the treatment of rheumatoid arthritis. Arthritis and Rheumatism 28: 721–730, 1985

    Article  PubMed  CAS  Google Scholar 

  • Winchester R, Bernstein DH, Fischer HD, Enlow R, Solomon G. The co-occurrence of Reiter’s syndrome and acquired immunodeficiency. Annals of Internal Medicine 106: 19–26, 1987

    PubMed  CAS  Google Scholar 

  • Wong DG, Spence JD, Lamki L, Freeman D, McDonald JWD. Effect of non-steroidal anti-inflammatory drugs on control of hypertension by beta-blockers and diuretics. Lancet 1: 997–1001, 1986

    Article  PubMed  CAS  Google Scholar 

  • Woodland J, Chaput de Saintonge DM, Evans SJW, Sharman VL, Currey HLF. Azathioprine in rheumatoid arthritis: a double-blind study of full versus half doses versus placebo. Annals of the Rheumatic Diseases 40: 355–359, 1981

    Article  PubMed  CAS  Google Scholar 

  • Wright V. Oral gold for rheumatoid arthritis. British Medical Journal 289: 858–859, 1984

    Article  PubMed  CAS  Google Scholar 

  • Zvaifler NJ. Antimalarial treatment of rheumatoid arthritis. Medical Clinics of North America 52: 759–764, 1968

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Lupus Research Laboratory, St Thomas’ Hospital, London, England

    C. S. Wolfe (Senior Registrar in Rheumatology) & G. R. V. Hughes

Authors
  1. C. S. Wolfe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. R. V. Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wolfe, C.S., Hughes, G.R.V. The Optimum Management of Arthropathies. Drugs 36, 370–381 (1988). https://doi.org/10.2165/00003495-198836030-00007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-198836030-00007

Keywords

Search

Navigation