Much thought is necessary before a cytotoxic drug is prescribed in patients suffering from rheumatic disorders. These drugs pose dual problems when used in chronic disease: firstly, there is the danger of immediate toxicity (which is, of course, true of most drugs), and secondly there is the risk of a long-term effect on spermatogenesis and oogenesis and the possibility of predisposition to lymphoreticular and solid tissue neoplasms. The potential hazards must be carefully weighed against anticipated benefit, and antimitotic drugs should only be used after a careful trial of less toxic alternatives. Discussion with the patient and family is always essential. These drugs should be viewed in a “3rd” or even “4th line” context.
KeywordsRheumatoid Arthritis Rheumatic Disease Lupus Nephritis Cytotoxic Drug Cyclophosphamide Therapy
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