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Update on Treatment of Rheumatoid Arthritis
Affiliation:1. Department of Biological Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;2. Department of Biology, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada;3. Department of Zoology, University of British Columbia, 6270 University Boulevard, Vancouver, BC V6T 1Z4, Canada;4. Bamfield Marine Sciences Centre, 100 Pachena Road, Bamfield, BC VOR 1B0, Canada;1. Department of Gastroenterology, Second Affiliated Hospital of Qiqihar Medical University, Heilongjiang Province 161000, China;2. Department of General Medicine, Qiqihar First Hospital, Heilongjiang Province 161005, China;1. Department of Orthopaedic Surgery, Division of Spine Surgery, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States;2. Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, United States
Abstract:
Objective:To review current treatment of rheumatoid arthritis (RA), as well as recent advances.Data Sources:MEDLINE search from 1990 to 1998 for human studies using search terms “rheumatoid arthritis”; “cyclooxygenase inhibitors” combined with “anti-inflammatory agents, nonsteroidal”; “tumor necrosis factor” limited to “antagonists and inhibitors”; “isoxazoles.”Data Synthesis:RA is a chronic inflammatory disease characterized by symmetrical joint involvement, usually of the small joints of the hands and feet. Although the hallmark of the disease is inflammation of joints, other organ systems—including the eyes, blood vessels, lungs, and car-diopulmonary system—may also be involved. Treatment of RA requires both drug and non drug approaches. Current drug therapy consists of combinations of nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs). Corticosteroids are also used either for short-term treatment during initiation of therapy, in bursts during acute disease flares, or chronically in low doses. A number of promising new agents are in development. NSAIDs with preferential inhibition of cyclooxygenase II may offer a better safety profile than existing agents. Leflunomide and biological agents such as etanercept may provide benefit for patients who fail to achieve adequate response from conventional therapy.Conclusion:Traditional approaches to treatment of RA include NSAIDs combined with DMARDs. New agents just reaching the market represent important advances and have the potential to make a positive impact on treatment of RA.
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