Which Antirheumatic Drug?

Summary

Successful therapy in a chronic rheumatic disease means choosing the right drug for the right patient with the right condition at the right time. In the treatment of gout three different types of treatment are given: for the acute episode, suppression and long-term therapy. Misuse of long-term therapy for acute gout will often aggravate the condition. As regards rheumatoid arthritis, in the absence of a known aetiology, treatment is essentially empirical and palliative; the use of milder well-tolerated anti-inflammatory agents for the less severe cases, more effective and more toxic agents for the more severe cases, and slow acting long-term agents for those not responding to previous measures is discussed. Night pain and morning stiffness has its own therapy. The place of corticosteroids throughout the whole field of rheumatology is evaluated. In the treatment of systemic lupus erythematosus corticosteroids still hold first place, but the cytotoxic (immunosuppressive) agents also play a part, though an arguable one.