Abstract
The prediction of a positive or negative outcome of antirheumatic drug therapy is made particularly difficult by the large number of medications available. In addition to simple analgesics, such as acetaminophen (paracetamol) and salicylates, some 100 or so nonsteroidal antiinflammatory analgesic agents (NSAIDs) are marketed worldwide or are at an advanced stage of development1. Some of these NSAIDs have now been licensed for purchase “over the counter” but no less than 17 have had to be withdrawn due to side-effects1. It has been estimated that approximately $1000 million is spent on nonsalicylate anti-inflammatory analgesics each year in the United States2 entailing no fewer than 700 000 prescriptions3. Cogent arguments in favor of early use of slow-acting antirheumatic drugs (SAARDs) in the treatment of rheumatoid arthritis4 have been persuasive not only for single agents but also for combinations of SAARDs5. Although most rheumatologists maintain that oral corticosteroids should rarely be used to treat patients with rheumatoid arthritis6, some 10-25% of such patients attending hospital outpatient clinics will be receiving these drugs6–9. It has been suggested that small doses of oral corticosteroids can be used to treat active rheumatoid arthritis without fear of significant side-effects10,11, even in elderly patients12,13. The encouraging results seen initially following the use of 1 g of intravenous methylprednisolone14,15 have waned somewhat since the demonstration of equivalent short-term clinical effects using 1 g oral prednisolone16 and the fact that clinical and immunologic response is transient17–19.
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References
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Brooks, P.M., Buchanan, W.W. (1991). Prediction of the clinical efficacy of and intolerance to antirheumatic drug therapy. In: Bellamy, N. (eds) Prognosis in the Rheumatic Diseases. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-3896-3_17
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