Three major classes of drugs are used in the treatment of patientswith rheumatoid arthritis: nonsteroidal antiinflammatory drugs,corticosteroids, and drugs that are thought to modify fundamentalpathologic processes responsible for the chronic inflammation.The agents in the last group have been classified accordingto their alleged benefit (as disease-modifying or remission-inducing),their onset or duration of action (slow-acting or long-acting),or their presumed mechanism of action (cytotoxic, immunosuppressive,or antiproliferative). Although they probably have propertiesin common, from a clinical standpoint each of these categoriesof drug has some unique effects on the clinical course of rheumatoidarthritis and, . . . [Full Text of this Article]
Mechanisms of Action
Randomized Clinical Trials of Second-Line Drugs
Second-Line Drugs in Clinical Practice
Earlier Use of Second-Line Drugs
Combination Therapy
Toxicity of Second-Line Drugs
Toxic Effects on the Liver
Toxic Effects on the Lungs
Toxic Effects on the Kidneys
Infection
Cancer
Teratogenicity
Conclusions
Source Information
From the Department of Rheumatic and Immunologic Diseases, Cleveland Clinic Foundation, Cleveland (J.M.C.), and the Arthritis and Rheumatism Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Md. (J.H.K.).
Address reprint requests to Dr. Klippel at the National Institutes of Health, Bldg. 10, Rm. 9S 205, Bethesda, MD 20892.
References
This article has been cited by other articles:
Fujishima, N., Sawada, K.-i., Hirokawa, M., Oshimi, K., Sugimoto, K., Matsuda, A., Teramura, M., Karasawa, M., Arai, A., Yonemura, Y., Nakao, S., Urabe, A., Omine, M., Ozawa, K.
(2008). Long-term responses and outcomes following immunosuppressive therapy in large granular lymphocyte leukemia-associated pure red cell aplasia: a Nationwide Cohort Study in Japan for the PRCA Collaborative Study Group. haematol
93: 1555-1559
[Abstract][Full Text]
Chen, H A, Lin, K C, Chen, C H, Liao, H T, Wang, H P, Chang, H N, Tsai, C Y, Chou, C T
(2006). The effect of etanercept on anti-cyclic citrullinated peptide antibodies and rheumatoid factor in patients with rheumatoid arthritis. Ann Rheum Dis
65: 35-39
[Abstract][Full Text]
Richy, F, Bruyere, O, Ethgen, O, Rabenda, V, Bouvenot, G, Audran, M, Herrero-Beaumont, G, Moore, A, Eliakim, R, Haim, M, Reginster, J-Y
(2004). Time dependent risk of gastrointestinal complications induced by non-steroidal anti-inflammatory drug use: a consensus statement using a meta-analytic approach. Ann Rheum Dis
63: 759-766
[Abstract][Full Text]
van Aken, J, Lard, L R, le Cessie, S, Hazes, J M W, Breedveld, F C, Huizinga, T W J
(2004). Radiological outcome after four years of early versus delayed treatment strategy in patients with recent onset rheumatoid arthritis. Ann Rheum Dis
63: 274-279
[Abstract][Full Text]
Gamerdinger, K., Moulon, C., Karp, D. R., van Bergen, J., Koning, F., Wild, D., Pflugfelder, U., Weltzien, H. U.
(2003). A New Type of Metal Recognition by Human T Cells: Contact Residues for Peptide-independent Bridging of T Cell Receptor and Major Histocompatibility Complex by Nickel. JEM
197: 1345-1353
[Abstract][Full Text]
Paran, D, Elkayam, O, Mayo, A, Paran, H, Amit, M, Yaron, M, Caspi, D
(2001). A pilot study of a long acting somatostatin analogue for the treatment of refractory rheumatoid arthritis. Ann Rheum Dis
60: 888-891
[Abstract][Full Text]
Emery, P., Breedveld, F. C., Lemmel, E. M., Kaltwasser, J. P., Dawes, P. T., Gomor, B., Van den Bosch, F., Nordstrom, D., Bjorneboe, O., Dahl, R., Horslev-Petersen, K., Rodriguez de la Serna, A., Molloy, M., Tikly, M., Oed, C., Rosenburg, R., Loew-Friedrich, I., , t. M. L. S. G.
(2000). A comparison of the efficacy and safety of leflunomide and methotrexate for the treatment of rheumatoid arthritis. Rheumatology (Oxford)
39: 655-665
[Abstract][Full Text]
Goldring, S. R.
(2000). A 55-Year-Old Woman With Rheumatoid Arthritis. JAMA
283: 524-531
[Full Text]
Moreland, L. W., Schiff, M. H., Baumgartner, S. W., Tindall, E. A., Fleischmann, R. M., Bulpitt, K. J., Weaver, A. L., Keystone, E. C., Furst, D. E., Mease, P. J., Ruderman, E. M., Horwitz, D. A., Arkfeld, D. G., Garrison, L., Burge, D. J., Blosch, C. M., Lange, M. L.M., McDonnell, N. D., Weinblatt, M. E.
(1999). Etanercept Therapy in Rheumatoid Arthritis: A Randomized, Controlled Trial. ANN INTERN MED
130: 478-486
[Abstract][Full Text]
Wakisaka, S., Suzuki, N., Takeno, M., Takeba, Y., Nagafuchi, H., Saito, N., Hashimoto, H., Tomita, T., Ochi, T., Sakane, T.
(1998). Involvement of simultaneous multiple transcription factor expression, including cAMP responsive element binding protein and OCT-1, for synovial cell outgrowth in patients with rheumatoid arthritis. Ann Rheum Dis
57: 487-494
[Abstract][Full Text]
Brus, H. L M, van de Laar, M. A F J, Taal, E., Rasker, J. J, Wiegman, O.
(1998). Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis. Ann Rheum Dis
57: 146-151
[Abstract][Full Text]
O'Dell, J. R., Haire, C. E., Erikson, N., Drymalski, W., Palmer, W., Eckhoff, P. J., Garwood, V., Maloley, P., Klassen, L. W., Wees, S., Klein, H., Moore, G. F.
(1996). Treatment of Rheumatoid Arthritis with Methotrexate Alone, Sulfasalazine and Hydroxychloroquine, or a Combination of All Three Medications. NEJM
334: 1287-1291
[Abstract][Full Text]
Tugwell, P., Pincus, T., Yocum, D., Stein, M., Gluck, O., Kraag, G., McKendry, R., Tesser, J., Baker, P., Wells, G., The Methotrexate-Cyclosporine Combination Study Gr,
(1995). Combination Therapy with Cyclosporine and Methotrexate in Severe Rheumatoid Arthritis. NEJM
333: 137-142
[Abstract][Full Text]
Bradlow, A., David, J.
(1995). Recent Advances: Rheumatology. BMJ
310: 637-640
[Full Text]
Previous
