Rheumatoid arthritis (RA) is a chronic, potentially destructive, systemic, autoimmune form of arthritis. It affects roughly 2 million Americans and has been the subject of intense research, particularly in recent years.
The goal of treatment is to induce remission.
In a previous article I discussed the use of non-steroidal anti-inflammatory drugs (NSAIDS) and glucocorticoids in rheumatoid arthritis (RA). In this article I will discuss disease-modifying anti-rheumatic drugs. (DMARDS).
Although non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids (0steroids0) may alleviate symptoms, joint damage can progress in patients with active rheumatoid arthritis (RA). Disease-modifying anti-rheumatic drugs (DMARDs) can reduce or prevent joint damage, preserve joint integrity and function, and maintain the economic productivity of the patient with RA.
DMARD therapy should be considered in all patients with active RA. DMARD therapy should be started immediately- certainly within 3 months of diagnosis- in any patient, who has persistent joint pain, significant morning stiffness or fatigue, active joint inflammation, persistent elevation of the ESR (sed rate) or CRP level (these latter two are blood tests that measure inflammation), or x-ray joint damage.
For any untreated patient with persistent joint inflammation and joint damage, DMARD treatment should be started to prevent or slow further damage. Unfortunately, all DMARDS including methotrexate (MTX), […]

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