title: Effectiveness and toxicity considerations in outcome directed therapy in rheumatoid arthritis.
abstract: New paradigms of disease modifying antirheumatic drug based treatment strategies for rheumatoid arthritis (RA) raise new questions of sequencing of medications and employment of combination therapy. A broader view of chronic illness indicates that nonbiologic and self-management factors influence disease course and necessitate inclusion of patient oriented outcome measures such as disability and pain. I discuss these and related issues, present a broad model of disease progression in RA, introduce the concept of the "therapeutic segment," describe the dependence of clinical results on immediately prior therapy, and suggest a new research approach into the merits of combination therapy. Effectiveness is not necessarily increased by addition of a 2nd drug, nor is toxicity necessarily increased by combination therapy.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, CA, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Fries
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D006801:Humans; D008962:Models, Theoretical; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents