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Previous Volume 330:1368-1375 May 12, 1994 Number 19 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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Three major classes of drugs are used in the treatment of patients with rheumatoid arthritis: nonsteroidal antiinflammatory drugs, corticosteroids, and drugs that are thought to modify fundamental pathologic processes responsible for the chronic inflammation. The agents in the last group have been classified according to 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 properties in common, from a clinical standpoint each of these categories of drug has some unique effects on the clinical course of rheumatoid arthritis 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

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• 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. J. Exp. Med. 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]  
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• Bradlow, A., David, J. (1995). Recent Advances: Rheumatology. BMJ 310: 637-640 [Full Text]