DRUG-THERAPY OF RHEUMATOID-ARTHRITIS

Rheumatoid arthritis (RA) is a chronic inflammatory disease that affec ts approximately 1% of the population worldwide. It is present in wome n 2-3 times more often than men. The traditional therapeutic regimen i s to start with a nonsteroidal antiinflammatory drug (NSAID). If the p atient has evidence of radiological abnormalities such as erosions, ma rked inflammatory disease or rheumatoid factor positivity, the medical regimen is to supplement with second-line remittive agents, or diseas e modifying agents (disease modifying antirheumatic drugs [DMARDs]) in the first 2 years to control disease activity in these patients. Ther e are numerous DMARDs available, including hydroxychloroquine, methotr exate, gold (oral or intramuscular), sulfasalazine, D-penicillamine, a zathioprine, alkylating agents, corticosteroids and novel agents such as cyclosporine. Current clinical practices are moving towards the ear lier introduction of these DMARDs and use of combinations of these dru gs has been emphasized greatly in the last few years. Toxicities can d evelop from NSAIDs and DMARDs and must be monitored for the appropriat e drug. Overall, the therapy of RA remains individualized and is often determined by the degree of disease activity, functional status and c oncerns about the toxicity profile of a potential regimen.