A short history of anti-rheumatic therapy - VI. Rheumatoid arthritis drugs

Abstract

The treatment of rheumatoid arthritis traditionally includes symptomatic drugs, showing a prompt action on pain and inflammation, but without any influence on disease progression, and other drugs that could modify the disease course and occasionally induce clinical remission (DMARDs or disease modifying anti-rheumatic drugs). This review describes the historical steps that led to the use of the main DMARDs in rheumatoid arthritis, such as gold salts, sulphasalazine, chloroquine and hydroxychloroquine, D-penicillamine, and other immunoactive drugs, including methotrexate, azathioprine, cyclosporin and leflunomide. The historical evolution of use of these drugs is then discussed, including the strategy of progressive ("therapeutic pyramid") or of more aggressive treatment, through the simultaneous use of two or more DMARDs ("combination therapy").

Short story of antirheumatic therapy.VIII. The immunodepressants

“…Leflunomide also has the right to be considered as one of the group of immunodepressant drugs. However, here we will add nothing to what has already been written regarding its use in the treatment of rheumatoid arthritis given that, at least for the moment, it has only been used in the treatment of this particular disease (13). It is important to remember that even cortisones, at least at high doses, depress the immune system, and that many of the hetereogenous class of molecules which modify the aggressiveness of RA and improve the disease course (gold salts, chinolinics, thiols) interfer in some way with the immune mechanisms even though none of them can be considered immunodepressants in the strictest sense.…”