Approach to the patient with rheumatoid arthritis.
RA remains a therapeutic challenge. Despite substantial data from therapeutic trials, the precise therapy of this often debilitating disease remains controversial. A variety of agents are available to the clinician for the treatment of this disease, yet the precise timing of their use and the determination of situations in which efficacy is most likely to be observed is still unclear. However, it is obvious that earlier intervention and more aggressive forms of therapy are currently advocated by most rheumatologists. Given the rapidity with which this disease can induce substantial morbidity, the use of second-line agents early in the course of this process is warranted. Whether or not combination therapy provides any benefit is still unproved. As our understanding of the pathogenic mechanisms involved in the development of RA evolve, and with the development of newer immunomodulatory agents, it is likely that more specific forms of therapy can be developed. It is hoped that these protocols will permit more precise treatment of the abnormalities leading to this disease without global suppression of the immune system or other unacceptable side effects.
Slotkoff
A T
AT
Department of Medicine, Georgetown University Medical Center, Washington, D.C.
Katz
P
P
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007167:Immunotherapy; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D010396:Penicillamine / Q000627:therapeutic use; D012460:Sulfasalazine / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000962:Antimalarials; D007166:Immunosuppressive Agents; D012460:Sulfasalazine; D010396:Penicillamine; D008727:Methotrexate