Stopping the rot: the stories behind methotrexate, sulphasalazine and hydroxychloroquine

Untreated rheumatoid arthritis (RA) has devastating effects on joint structure, function and quality of life. Treatment has improved over the last few decades as the emphasis has switched from empiric symptomatic treatment with non-steroidal anti-inflammatory drugs to early introduction of disease-modifying anti-rheumatic drugs (DMARDs), and in severe disease, biological DMARDs. We review the history of methotrexate, sulphasalazine and hydroxychloroquine and reflect on how individual studies, world events and the discovery of cortisone may have 'robbed' a generation of RA patients of the treatments still used today - in particular methotrexate and sulphasalazine.