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August 6, 1982

Treatment of Rheumatoid Arthritis

JAMA. 1982;248(5):546. doi:10.1001/jama.1982.03330050030015

To the Editor.—  The unfortunate choice of the title "The Safety of Treating Rheumatoid Arthritis With Aspirin" in the editorial by Eric P. Gall, MD, published in The Journal (1982;247:63) no doubt contributed to confused, wide media coverage, which interpreted aspirin in a high-dosage regimen as a "safe drug of first choice in treating most patients with rheumatoid arthritis." While this bias may at one time, indeed, have been acceptable, it is now subject to serious challenge, as almost 100 new alternative nonsteroidal anti-inflammatory and nonacetylated salicylate agents are compared with aspirin. None are necessarily superior in anti-inflammatory effect to aspirin when aspirin is taken appropriately at high-dose anti-inflammatory levels. All are consistently less toxic to the upper gastrointestinal (GI) tract, however.1Acid peptic complications are the most common and troublesome problems of anti-inflammatory therapy. I have recently reported on 137 patients with rheumatoid arthritis and osteoarthritis who had