ADVANCES AND ISSUES IN THE PHARMACOTHERAPY OF RHEUMATOID-ARTHRITIS

Rheumatoid arthritis (RA) is an unremitting and progressive disease de spite the use of second-line drugs in the majority of patients. In add ition, a shortened life-span directly attributable to RA is now recogn ized. The additions of methotrexate and sulfasalazine to the therapeut ic armamentarium represent important treatment advances during the pas t decade. To improve the effectiveness of second-line drug therapy, ea rlier intervention and use of these newer drugs in combination with ol der second-line drugs is being advocated. Several proposed strategies for intervening earlier, combining second-line drugs, and/or improving patient selection for second-line drug therapy are reviewed. Systemat ic evaluation of these strategies is needed. Controlled studies to dat e have not demonstrated combining second-line drugs is superior to usi ng individual second-line agents. Future advances in optimizing patien t outcomes with these drugs will require systematic screening for pote ntially strategies followed by supportive effectiveness in the form of large-scale studies.