DMARDs in the treatment of rheumatoid arthritis: current agents and future developments

The purpose of this paper is to review the benefits and limitations of current disease-modifying antirheumatic drugs (DMARDs) used for the treatment of rheumatoid arthritis (RA). Literature about DMARD use in RA, both as monotherapy and in combination therapy, is reviewed. The efficacy and safety of methotrexate, antimalarials, gold-containing compounds, sulphasalazine, D-penicillamine, azathioprine and cyclosporin, as well as several new antirheumatic agents are considered. Controlled short-term clinical studies demonstrate that DMARDs are superior to placebo. Early and continuous use of DMARDs is necessary to slow joint damage and improve long-term outcomes. Unfortunately, long-term treatment with these drugs is frequently limited by loss of response and/or onset of serious adverse events. The efficacy of combination DMARD therapy has also been tested, but with mixed success, and the goals of combination DMARD therapy have yet to be fully realised. New DMARDs that have recently been introduced offer promise for future RA management.