Severe progressive rheumatoid arthritis remains a therapeutic challenge. The usual approach has been described by Wilbur Blechman as resembling choices from a Cantonese restaurant menu—take one or more from column A and also from column B. Thus, the control of inflammation, or at least of the symptoms produced by inflammation, is made a responsibility of nonsteroidal antiinflammatory drugs and, in some cases, of corticosteroids. At the same time, inhibition of the progression of the disease generally requires addition of disease-modifying antirheumatic drugs, also known as remission-inducing drugs, such as gold salts, penicillamine, antimalarials, azathioprine, and a variety of experimental drugs and procedures borrowed from the treatment of other diseases. Gold compounds were first introduced because of a confusion between tuberculosis and rheumatoid arthritis; penicillamine began as an agent to remove copper from patients who had Wilson's disease; chloroquine and hydroxychloroquine sulfate were used to prevent or treat malaria, while azathioprine
Ehrlich GE. Heroic Treatment for Nonmalignant Disease. JAMA. 1982;248(14):1743–1744. doi:10.1001/jama.1982.03330140053034
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