The medical treatment of rheumatoid arthritis has been dramatically improved with the
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1 DOI: /jkma pissn: eissn: Focused Issue of This Month Medical treatment of rheumatoid arthritis (I): Nonsteroidal anti-inflammatory drugs, disease modifying antirheumatic drugs and glucocorticoids Eun-Mi Koh, MD Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Received August 2, 2010 Accepted August 16, 2010 Abstract The medical treatment of rheumatoid arthritis has been dramatically improved with the advances of newer disease-modifying antirheumatic drugs (DMARDs) and biologic agents during previous decades. To prevent joint damage, it is essential to start DMARD treatment early, especially within the first 3 months after diagnosis. Tight control of disease activity, and the thorough monitoring of the treatments efficacy and the side effects of medications are also important. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually used to control pain and swelling of the joints. However, these drugs cannot alter the disease course of rheumatoid arthritis. It is therefore necessary to introduce DMARDs at the beginning of treatment, and, after achieving the effect of DMARDs, NSAIDs should be tapered as soon as possible. The main treatment should be DMARDs, which must be used wisely and appropriately. It is also important to adjust DMARD therapy during the course of treatment according to disease activity. Glucocorticoids have potent anti-inflammatory effects and can control inflammation dramatically. However, because of the diverse and serious side effects of glucocorticoids, the usage of glucocorticoids should be limited to low-dose oral therapy or intra-articular injection, unless otherwise indicated. Along with biologics, there are now various weapons available against rheumatoid arthritis, and it can be treated much more effectively than before. Keywords: Rheumatoid arthritis; NSAIDs; DMARDs; Glucocorticoids c Korean Medical Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 871
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8 Koh EM REFERENCES 11. American College of Rheumatology Ad Hoc Committee On Clinical Guidelines: Guidelines for the management of rheumatoid arthritis; 2002 Update. Arthritis Rheum 2002; 46: Bathon JM, Cohen SB. The 2008 American College of Rheumatology recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis: Where the rubber meets the road. Arthritis Rheum 2008; 59: American College of Rheumatology Ad Hoc Committee on Clinical Guidelines. Guidelines for the management of rheumatoid arthritis. Arthritis Rheum 1996; 39: Schur PH, Maini RN. Treatment of early, moderately active rheumatoid arthritis in adults. UpToDate Website. Available at: heumart/15723&selectedtitle=1%7e150&source=search_res ult. Accessibility verified on July 21, Wilske KR, Healey LA: Remodeling the Pyramid-a Concept Whose Time Has Come. J Rheumatol 1989; 16: Klippel JH, Stone JH, Crofford LJ, White PH eds. Primer on the Rheumatic Diseases. 13th ed. Atlanta: Arthritis Foundation; Chapter 41, Nonsteroidal anti-inflammatory drugs; p Hawkey CJ: COX-2 inhibitors. Lancet 1999; 353: Chan FK, Lanas A, Scheiman J, Berger MF, Nguyen H, Goldstein JL. Celecoxib versus omeprazole and diclofenac in patients with osteoarthritis and rheumatoid arthritis (CON- DOR): a randomized trial. Lancet 2010; 376: Deighton C, OMahony R, Tosh J, Turner C, Rudolf M. Management of rheumatoid arthritis: summary of NICE guidance. BMJ 2009; 338: b Tannenbaum H, Bombardier C, Davis P, Russell AS. An evidence-based approach to prescribing nonsteroidal antiinflammatory drugs. Third Canadian Consensus Conference. J Rheumatol 2006; 33: Fauci A, Braunwald E, Kasper D, Hauser S, Longo D, Jameson J, Loscalzo J, eds. Harrisons Principles of Internal Medicine(Korean Language Edition). 17th ed. McGraw-Hill; Chapter 316, Rheumatoid arthritis; p Hochberg MC, Silman AJ, eds. Rheumatology. 4th ed. London: Mosby; Chapter 42, Disease-modifying antirheumatic drugs 2:sulfasalazine; p Kremer JM. Use of methotrexate in the treatment of rheumatoid arthritis. UpToDate Website. Available at: uptodate.com/online/content/topic.do?topickey=rheumart/54 50&selectedTitle=6%7E151&source=search_result, Accessibility verified on July 21, Hochberg MC, Silman AJ, eds. Rheumatology. 4th ed. London: Mosby; Chapter 44, Disease-modifying antirheumatic drugs 4:leflunomide; p Hochberg MC, Silman AJ, eds. Rheumatology. 4th ed. London: Mosby; Chapter 47, Other drugs in rheumatic disease; p Saag KG, Teng GG, Patkar NM, Anuntiyo J, Finney C, Curtis JR, Paulus HE, Mudano A, Pisu M, Elkins-Melton M, Outman R, Allison JJ, Suarez Almazor M, Bridges SL Jr, Chatham WW, Hochberg M, MacLean C, Mikuls T, Moreland LW, O Dell J, Turkiewicz AM, Furst DE. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum 2008; 59: Small RE: Use of glucocorticoids in the treatment of rheumatoid arthritis. UpToDate Website. Available at: uptodateonline.com/online/content/topic.do?topickey=rheum art/8827&selectedtitle=45%7e150&source=search_result#, Accessibility verified on July 21, Nieman LK: Pharmacologic use of glucocorticoids. UpToDate Website. Available at: content/topic.do?topickey=adrenal/12178&selectedtitle=2% 7E150&source=search_result#, Accessibility verified on July 21, Hoes JN, Jacobs JW, Boers M, Boumpas D, Buttgereit F, Caeyers N, Choy EH, Cutolo M, Da Silva JA, Esselens G, Guillevin L, Hafstrom I, Kirwan JR, Rovensky J, Russel A, Saag KG, Svensson B, Westhoven R, Zeidler H, Bijlsma JW. EU- LAR evidence-based recommendations on the management of systemic glucocorticoid therapy in rheumatic diseases. Ann Rheum Dis 2007; 66:
9 Medical treatment of rheumatoid arthritis (I): Nonsteroidal anti-inflammatory drugs, disease modifying antirheumatic drugs and glucocorticoids Peer Reviewers Commentary 879
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