Monday 16 October, 2006
DMARDs for rheumatoid arthritis
The treatment of rheumatoid arthritis has completely changed since I was at medical school. During that time, we were still being taught the “pyramid” of treatment with mild analgesics (e.g., paracetamol and NSAIDs) at the bottom, and disease-modifying antirheumatic drugs (DMARDs) at the top. Current thinking is that early treatment with DMARDs and what was once “second-line” agents provide better outcomes (1), though it is perhaps interesting to note that long term outcomes are not clear compared to the older pyramidal approach (2).
This month’s insert from the National Prescriber Service was an excellent two page summary of the DMARDs available in Australia for rheumatoid arthritis, with dosing strategy, contraindications, and monitoring protocols (3). It is a highly valuable and recommended resource.
(1) Wilske K., Healey L. Remodeling the pyramid – a concept whose time has come. J Rhematol. 1989 May;16(5):565-7. [Link PubMed]
(2) Scott D. Evidence for early disease-modifying drugs in rheumatoid arthritis. Arthritis Res Ther. 2004; 6(1): 15–18. [download PDF :: 44 Kb]
(3) Disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis. National Prescriber Service. October 2006. [download PDF :: 65 Kb]