Combination of sulphasalazine and methotrexate in the treatment of rheumatoid arthritis

Journal/Book: Z Rheumatol 1998; 57: 031 - 033. 1998;

Abstract: M. Dougados; Professor of Rheumatology Hôpital Cochin Assistance Publique - Hôpitaux de Paris Université René Descartes Pharmacotherapy of rheumatoid arthritis Rheumatoid arthritis is an illness characterized by a chronic polyarthritis often involving hands and wrists. It is capricious in its prognosis. While a minority of patients will have a relatively mild non-destructive synovitis of limited duration most will have an exacerbating and remitting arthritis ultimately leading to destruction of joints and surrounding structures. Numerous ongoing longitudinal epidemiological studies try to pick-up the predisposing factors of severity of the disease. Such factors are not well known. However the results of the available yet conducted studies suggest that both socioeconomical factors (and particularly the level of education) genetic factors (and particularly the presence of the shared epitope) and also the level of disease activity during the first year of the disease (and particularly CRP levels number of synovitis) could be considered as potential factors predictive of a poor articular long term outcome defined by articular damage assessed by X-rays (1 - 5). The treatment of the patients suffering from rheumatoid arthritis consists of drugs surgery occupational and physical therapies combined with psychosocial support. The principal therapeutic modality directed at the inflammatory process is the pharmacological one. Drugs against rheumatoid arthritis can be arbitrarily divided in first and second line agents. Second line agents are known by some other names: disease modifying antirheumatoid drugs (DMARDs) or slow acting anti-rheumatic drugs indicating the intended influence on the rheumatoid process or their onset of action. The "DMARDs" are doubted by several authors in their capacity to fulfill the promise of real change of prognosis (6 7). ... le

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