[Differential indications in rheumatism therapy on the basis of well-known drug side effects]

Special effects and side effects of antirheumatic basic treatment and symptomatic drugs, lead to distinct indications in the management of rheumatic diseases. Chloroquine should mainly be administered in "lupoid" rheumatoid arthritis (R.A.), in systemic lupus erythematosus, and in less active initial stages of R.A., whereas gold and D-penicillamine should be used in more active early stages of R.A. In psoriatic arthritis there is no contraindication for gold D-penicillamine, however, is less effective. Immunosuppressive agents may be used in special cases of R.A. and connective tissude diseases. However, strict controls and special care are necessary. Additive organ disorders may lead to individual contra-indications for basic treatment. All these drugs are not harmless and need careful control. In "lupoid" R.A. corticoids are superior to nonsteroidal antirheumatic drugs. The association of the conversion of R.A. into necrotizing vasculitis has been suggested. There is, however, no proof for this assertion. The new nonsteroidal antirheumatic drugs are assumed to have less side effects, but their real position may be evaluated only after much longer periods of administration. Rare, but severe side effects, especially due to the hematopoetic system, are problbly caused by an incompatibility of the patient. One must not forget the advantages for millions of rheumatic patients. Also, in an age of an exaggerated desire for security, special consideration must be given to these advantages, so that the development of new antirheumatic drugs is not suppressed.