CLINICAL-PHARMACOLOGY AND MODIFICATION OF AUTOIMMUNITY AND INFLAMMATION IN RHEUMATOID DISEASE

The increased understanding of the mechanisms which underlie rheumatoi d disease has been accompanied by a more appropriate use of the limite d repertoire of therapeutic agents. Conventional second-line drugs sti ll have a role in everyday practice. The efficacy of these agents in r educing the severity of clinical signs of joint inflammation, whilst a t the same time causing significant reductions in the laboratory measu res of the acute phase response is undoubtedly confirmed by meta-analy sis of several therapeutic trials of these agents. Whether or not thes e agents can influence outcome, usually assessed in terms of radiologi cal progression, is more contentious. Furthermore, their toxicity in l ong term use is not inconsiderable. However, newer agents may play a m ore important part in therapy in the future. Such therapy can be desig ned to specifically interfere with the abnormalities of the immune sys tem which characterise rheumatoid arthritis. Many of the agents review ed have been successfully applied to animal models of arthritis, but w e still await large randomised controlled studies in humans to determi ne their clinical efficacy and toxicity. In view of the complexity of the immunological abnormalities in rheumatoid arthritis, it may be nec essary to consider using a number of such agents in any particular pat ient. This should result in more rational therapy in rheumatoid arthri tis.