Does partial control of inflammation prevent long-term joint damage ? Clinical rationale for combination therapy with multiple disease-modifying antirheumatic drugs
T. Pincus, F.C. Breedveld, P. Emery
ABSTRACT
Only a decade ago, combination disease-modifying antirheumatic drug (DMARD) therapy was
regarded as an unusual approach to patients with rheumatoid arthritis (RA), reserved for
only a few patients with the most severe disease (1-3). At this time, however, almost all
rheumatologists use combination DMARD therapy in as many as 24% of patients (4, 5). This
shift in the approach to people with RA may be explained in part by three developments
over the last decade: accurate description of the natural history of RA; availability of
improved DMARDs - most notably methotrexate; and perhaps, above all, recognition that
partial control of inflammation likely does not prevent joint damage. These developments
are discussed briefly below.
Key words
Rheumatoid arthritis, combination therapy, disease-modifying anti-rheumatic drug,
outcome, damage.
Please address correspondence to: Prof. Theodore Pincus, M.D., Division of Rheumatology and Immunology, Vanderbilt University School of Medicine, 203 Oxford House, Box 5, Nashville, TN 37232-4500, USA.
Clin Exp Rheumatol 1999; 17 (Suppl. 18): S2 - S7.
© Copyright Clinical
and Experimental Rheumatology
1999.