Combination therapy for rheumatoid arthritis with methotrexate and cyclosporine

Journal/Book: Z Rheumatol 1998; 57: 034 - 036. 1998;

Abstract: T. Pincus; Professor of Medicine Division of Rheumatology and Immunology Vanderbilt University School of Medicine Nashville Combination therapy for rheumatoid arthritis (RA) with more than one diseasemodifying antirheumatic drug (DMARD) has gained considerable interest over the last few years (1). The rationale for combination of DMARD therapy includes several important considerations: The "side effects" of RA are generally considerably more severe than the side effects of drugs used to treat RA Historically many physicians and patients regarded the side effects of drugs to treat RA as potentially more severe than the "side effects" of disease (2). The dictum of Hippocrates "primum non nocere" (first do no harm) remains applicable in medical care today. However for most patients the "side effects" of RA significant functional declines radiographic progression economic losses and shortened life span (3 - 12) are considerably greater than the "side effects" of therapy. The physician may be doing more harm by not treating a patient with RA than by treating early and aggressively. Epidemiologic studies indicating that most people who meet Criteria for RA have spontaneous remission are not applicable to patients seen in clinical settings It was recognized in epidemiologic studies published in the 1960s that about 75 % of people who met Criteria for RA had no evidence of disease 3 - 5 years later (13 14). These people and some patients with RA seen in clinics have Type I RA - a selflimited process (15). By contrast most patients seen in clinical settings even in community settings (16) have Type III RA or persistent inflammatory symmetrical arthritis (PISA) (17 18) - a progressive disease which has not been adequately controlled by traditional therapies. ... le

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