Therapeutic Progress—review Vitreatment of Rheumatoid Arthritis

Abstract

SUMMARY Anti‐rheumatic drugs used in rheumatoid arthritis fall into two distinct groups: non‐steroidal anti‐inflammatory and second‐line drugs. Non‐steroidal anti‐inflammatory drugs give early symptomatic improvement and reduce the degree of acute inflammatory synovitis. Second‐line drugs such as gold or D penicillamine exert an anti‐inflammatory effect only after two to three months and act by suppressing disease activity: these reduce the ESR and other acute phase responses. However, the evidence that any of these drugs halt the progression of radiological changes or can be used as long‐term agents to control the disease over a period of years is weak. The current use of anti‐rheumatic drugs follows a general pattern with nonsteroidal anti‐inflammatory drugs used alone in patients with mild disease, whereas patients with severe disease also receive second‐line drugs. As yet the long‐term effect of this policy is not known. Cytotoxic drugs should be restricted to patients with severe disease who either fail to respond to conventional second‐line drugs or have active extra‐articular disease, particularly those with vasculitis.