Wd. Blackburn, MANAGEMENT OF OSTEOARTHRITIS AND RHEUMATOID-ARTHRITIS - PROSPECTS ANDPOSSIBILITIES, The American journal of medicine, 100, 1996, pp. 24-30
Conventional drug therapy in rheumatoid arthritis (RA) has failed to c
ontrol the longterm morbidity and mortality associated with RA. Simila
rly, drug therapy for osteoarthritis (OA) can relieve symptoms, but it
is not clear that it alters progression of disease. Three classes of
drugs are widely used for treatment of RA: nonsteroidal anti-inflammat
ory drugs (NSAIDs), corticosteroids, and the slow-acting agents. In mo
st patients, pharmacologic therapy is initiated with NSAIDs. These dru
gs can relieve symptoms but do not alter the course of the disease. Th
e gastrointestinal and other side effects attributed to these compound
s are well known. Similarly, use of corticosteroids can provide rapid
pain relief to patients with RA and, if used in low doses, pose limite
d risk of toxicity. Slow-acting agents, including gold, D-penicillamin
e, and methotrexate, appear to decrease radiographic progression and i
mprove clinical and biochemical indicators of RA. Therefore, newer tre
atment philosophies encourage use of slow-acting agents earlier in the
course of the disease in order to prevent or diminish bone and joint
erosions and destruction and other manifestations of disease progressi
on. Drugs under investigation for the treatment of arthritis appear to
exhibit disease-modifying or immunomodulating properties. Tenidap is
a novel agent that possesses a dual mechanism of action: cyclooxygenas
e inhibition and modulation of cytokine activity. In addition, several
biologic agents, including antibodies to tumor necrosis factor-alpha
(TNF-alpha) and to intercellular adhesion molecule-1, may prove useful
. These immunotherapeutic strategies are based on knowledge of the rol
e of cytokines in the inflammatory process in arthritis. Osteoarthriti
s may be managed using drug and nondrug modalities. Weight loss is esp
ecially important when OA is in the weight-bearing joints. Biopsies of
synovium from patients with OA show evidence of inflammation, but whe
ther this disease should be treated with analgesics alone or with anti
-inflammatory drugs remains controversial. Other treatment modalities,
including tissue transplants and cytokine-modulating drugs, are emerg
ing for the potential therapy of OA. Surgery may also be appropriate i
f drug treatment fails to control symptoms.