Pharmacotherapy of rheumatoid arthritis: an overview

• Published in: Current therapeutic research Vol. 62; no. 2; pp. 92 - 112
• Main Author: El Desoky, Ehab S.
• Format: Journal Article
• Language: English
• Published: Belle Mead, NJ EM Inc USA 01.02.2001; Excerpta medica
• Subjects: biologic agents; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; cyclooxygenase-2 inhibitors; leflunomide; Medical sciences; Pharmacology. Drug treatments; rheumatoid arthritis; leflunomide; biologic agents; rheumatoid arthritis; cyclooxygenase-2 inhibitors; Human; Immunopathology; Chemotherapy; Chronic; Treatment; Rheumatoid arthritis; Diseases of the osteoarticular system; Autoimmune disease; Inflammatory joint disease; Review
• ISSN: 0011-393X; 1879-0313
• DOI: 10.1016/S0011-393X(01)80020-5

Objective: The aim of this article was to provide an overview of the pharmacotherapy of rheumatoid arthritis (RA), including traditional drugs and the newer agents. Methods: Primary literature on the pharmacotherapy of RA was identified through a comprehensive MEDLINE ® English-language search from January 1985 to September 2000. Additional studies were identified from a review of the references within these sources. Results: Treatment options for RA are expanding as research has provided a more explicit understanding of the pathophysiology of the disease. For the relief of the signs and symptoms of RA, the new selective cyclooxygenase-2 (COX-2) inhibitors (celecoxib and rofecoxib) are joining the available nonsteroidal anti-inflammatory drugs (NSAIDs). COX-2 inhibitors have fewer associated upper gastrointestinal side effects than traditional NSAIDs. Use of disease-modifying antirheumatic drugs (DMARDs) is now recommended early in the disease. Triple therapy with methotrexate (MTX), sulfasalazine, and hydroxychloroquine is one of the successful combination approaches with DMARDs. Leflunomide, a new second-line DMARD, reduces pyrimidine synthesis and decreases rheumatoid inflammation. Leflunomide is as effective as MTX, but unlike MTX, does not cause bone marrow toxicity. The biologic agents etanercept and infliximab have shown benefit alone and in combination with MTX. They have minimal toxicity, except for injection-site reactions. However, they should be reserved for patients who fail to respond to MTX alone or another DMARD.