Anti-rheumatic drugs

Abstract

Although the number of non-steroidal anti-inflammatory drugs is constantly augmented by the products of pharmaceutical research, clinicians have become increasingly aware of the serious limitations inherent in their use. Rheumatic diseases especially rheumatoid arthritis constitute one of the prime indications for their prescription, yet none of them appear to alter the long term prognosis of this crippling disease. However, such criticism may not apply to some of the more recent introductions to this important group such as Fenclofenac, Benoxaprofen. Clozic and Levamisole. More time is required to substantiate claims that these drugs reduce levels of erythrocyte sedimentation rate (ESR) and acute phase proteins (APP), whilst simultaneously inhibiting the progression of joint erosions. Treatment of the rheumatic diseases has always proved difficult because of the lack of knowledge of their etiology. Despite an enormous research programme world wide during the past twenty years the precise cause of the majority of them remains obscure. Traditionally treatment has been mainly supportive and symptomatic, involving a multidisciplinary team of health care professionals under the overall supervision of a specialist physician trained in this branch of medicine. This situation is likely to be maintained until advancing knowledge ensures prevention or cure of them. There are already signs that optimism is justified from this point of view. We already have at our disposal drugs which appear to have the ability to influence favorably many of the features associated with, for example, rheumatoid arthritis. They may reduce ESR levels and APP concentrations (E.R.C. multi-centre trial of gold therapy, 1961a; Popert et al., 1961; Jail'e, 1970), and are also capable of reducing serum rheumatoid factor levels and inhibiting the development of new erosions or encouraging healing of established ones (Sigler et al., 1974~ Lukkainen et al., 1977J. Improvement of these objective parameters is reflected by subjective improvement of the patient manifest by reduction in severity of symptoms together with improvement in general health and well being. Such agents are usually referred to as anti-rheumatic drugs. They represent a diverse collection of apparently unrelated compounds including gold, chloroquine, penicillamine, levamisole and others to be described later. Their mode of action differs markedly from the non-steroidal anti-inflammatory group in view of their slow onset of action which may be delayed for up to three months. This is in complete contradistinction to the former group in which a clinical response may be anticipated within two weeks of commencing treatment.