Conventional disease-modifying antirheumatic drugs to treat rheumatoid arthritis

Rheumatoid arthritis (RA) is characterized by a symmetric polyarthritis of unknown etiology that, if untreated or unresponsive to therapy, typically leads to deformities and destruction of joints through the erosion of cartilage and bone. Currently available disease-modifying antirheumatic drugs (DMARDs) can control synovitis and may slow, or even stop, radiographic progression, improve function and quality of life, and normalize mortality rates. This review gives a brief overview on commonly used conventional DMARDs and their role in the current management of RA. Methotrexate is still considered the gold standard among the DMARDs, and is widely accepted as first-line treatment in the management of RA. Other DMARDs are less frequently used in monotherapy or as first-line agents but continue to have a role as antirheumatic agents in select patients. DMARD combination therapy may still represent a valuable therapeutic option in patients who fail to DMARD monotherapy or in whom combination therapy is considered initially. This review will focus on a better understanding of the critical importance of early DMARD treatment, the goal of remission and the need for tight control and adaptive modification in case of inadequate response or intolerance. Drug Dev Res 72:657663, 2011. (C) 2011 Wiley Periodicals, Inc.