Summary
A proposed new classification of antirheumatic therapy nominates two major categories, as follows.
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Symptom-modifying antirheumatic drugs (SM-ARDs) improve the symptoms and clinical features of inflammatory synovitis. They can be further categorised as: (I) nonsteroidal anti-inflammatory drugs; (II) corticosteroids; and (III) slower-acting drugs, e.g. antimalarials, gold, penicillamine, antimetabolites and cytotoxic agents.
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Disease-controlling antirheumatic therapy (DC-ART) changes the course of rheumatoid arthritis. These agents (a) improve and sustain function in association with decreased inflammatory synovitis, and (b) prevent structural joint damage, or significantly decrease its rate of progression. Changes must be sustained for a minimum period of 1 year. The classification must include reference to the time for which criteria have been satisfied, e.g. a 2-year DC-ART.
All currently available therapeutic agents are SM-ARDs. DC-ARTs are a new group and a new concept. The development of therapies in this category represents a major challenge to drug developers.
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References
Brooks PM. The use of suppressive agents for the treatment of rheumatoid arthritis. Aust NZ J Med 1993; 23: 193–204
Sigler JW, Bluhm GB, Duncan H, et al. Gold salts in the treatment of rheumatoid arthritis. Ann Intern Med 1974; 80: 21–6
Currey HLF, Harris J, Mason RN, et al. Comparison of azathioprine, cyclophosphamide and gold in the treatment of rheumatoid arthritis. Br Med J 1974; 3: 763–6
van der Heijde DMFM, van Riel PL, Nuver-Zwart IH, et al. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet 1989; 1: 1036–8
van der Heijde DMFM, van Riel PL, Nuver-Zwart IH, et al. Sulphasalazine versus hydroxychloroquine in rheumatoid arthritis: 3-year follow-up. Lancet 1990; 335: 539–41
Burg G, Allander E, Lund B, et al. Auranofin inproves outcome in early rheumatoid arthritis results from a 2-year double blind, placebo controlled study. J Rheumatol 1988; 15: 1747–54
WHO Report of the Fourth Joint WHO/ILAR Task Force Meeting on Rheumatic Diseases; 1991 8–10 July; Geneva. WHO/DBO/TFRD/91.1: 1–33
Development of testing protocols for antirheumatic drugs; NSAIDs. WHO Report of the Fourth Joint WHO/ILAR Task Force Meeting on Rheumatic Diseases; 1991 8–10 July; Geneva. WHO/DBO/TFRD/91.1: 25–31
Paulus HE, Scott DL, Edmonds JP. Classification of antirheumatic drugs: a new proposal. Arthritis Rheum 1992; 35: 364–5
Edmonds JP, Scott DL, Furst DE, et al. New classification of antirheumatic drugs: the evolution of a concept. J Rheumatol 1993; 20: 585–7
Edmonds JP, Scott DL, Furst DE, et al. Antirheumatic drugs: a proposed new classification [editorial]. Arthritis Rheum 1993; 36: 336–9
WHO Report of the Fifth Joint WHO/ILAR Task Force Meeting on Rheumatic Diseases; 1993 29 June–2 July; Geneva. In preparation
Boers M, Tugwell P, Felson DJ, et al. WHO and ILAR core endpoints for symptom modifying antirheumatic drugs in rheumatoid arthritis clinical trials. J Rheumatol. In press
Scott DL, Symmons DPM, Coulton BL, et al. Long term outcome of treating rheumatoid arthritis: results after twenty years. Lancet 1987; 1: 1108–11
Pincus T, Callahan L. Taking mortality in rheumatoid arthritis seriously — predictive markers, socioeconomic status and comorbidity. J Rheumatol 1986; 13: 841–5
Choy EHS, Kingsley GH. Immunotherapy, past, present and future. Br J Rheumatol 1993; 32: 89–92
Pinals RS, Masi AT, Larsen RA, et al. Preliminary criteria for clinical revision in rheumatoid arthritis. Arthritis Rheum 1981; 24: 1308–15
Fries JF, Spitz P, Kraines RG, et al. Measurement of patient outcome in arthritis. Arthritis Rheum 1980; 23: 137–45
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Edmonds, J. Reclassification of Antirheumatic Agents. Clin. Immunother. 1, 110–116 (1994). https://doi.org/10.1007/BF03258497
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DOI: https://doi.org/10.1007/BF03258497


