Disease-modifying antirheumatic drugs, including methotrexate, sulfasalazine, gold, antimalarials, and D-penicillamine.
Rheumatoid arthritis is a progressive inflammatory disease with evidence of early cartilage damage. Consequently, there is a trend toward earlier use of disease-modifying antirheumatic drugs. This review focuses on recent data on methotrexate, sulfasalazine, gold, hydroxychloroquine, D-penicillamine, and combination therapy. Methotrexate is focused on most, reflecting the increasing popularity of this agent; studies continue to show its good clinical efficacy. Combination therapy studies have been disappointing and are still marred by short duration and low power. Sulfasalazine has a fairly rapid onset of clinical effects and modulates immune function. Gold is still the subject of new studies, with evidence that clinical experience leads to improved patient efficacy. The beneficial effect of hydroxychloroquine in mild rheumatoid arthritis has been confirmed, and information on D-penicillamine suggests an effect on oxygen radical scavenging. Clinical studies are still required to ascertain the relative efficacy of these drugs, and potential long-term adverse effects remain a source of concern.
Conaghan
P G
PG
St. Vincent's Hospital, Sydney, Australia.
Brooks
P
P
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006046:Gold / Q000627:therapeutic use; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D010396:Penicillamine / Q000627:therapeutic use; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000503:physiopathology; D012460:Sulfasalazine / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000962:Antimalarials; D012460:Sulfasalazine; D006046:Gold; D010396:Penicillamine; D008727:Methotrexate