Challenging the pyramid. A new look at therapeutic approaches for rheumatoid arthritis. Earlier intervention with second line therapies.
It is clear that nonsteroidal antiinflammatory drugs (NSAID) may help control the pain and swelling of rheumatoid arthritis (RA) but do not retard joint destruction. Similarly, prednisone is effective in controlling pain and swelling but it cannot be established that it prevents or delays joint damage. When added to NSAID and prednisone, second line drugs (DMARD) have the potential to provide additional control of synovitis and improve function. Each second line drug has a unique tolerability and safety profile. Patients who are more likely to have a progressive course should be evaluated for second line drugs rather than risk irreversible damage.
Ward
J R
JR
Division of Rheumatology, University of Utah Medical Center, Salt Lake City 84132.
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D001310:Auranofin / Q000627:therapeutic use; D006052:Gold Sodium Thiomalate / Q000627:therapeutic use; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D006052:Gold Sodium Thiomalate; D001310:Auranofin; D008727:Methotrexate