[Drug therapy of rheumatoid arthritis]

Nowadays undisputed is the effectiveness of early and long-standing DMARD therapy in the presence of active rheumatoid arthritis on disease progression and avoidance of structural joint changes. "Early" is defined as immediate initiation of drug therapy after diagnosis of rheumatoid arthritis. "Long-term" refers to a mostly life-long therapy, which even in the case of remission should be continued for at least 1 year. Clinical and laboratory routine controls during DMARD therapy are absolutely necessary. "DMARDs" summarize disease-modifying antirheumatic drugs such as methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, aurum but also the TNF-blockers infliximab and etanercept. In cases of disease remission with combination drug therapy, corticosteroids and NSAID should be discontinued in a timely manner ahead of DMARDs to ensure that the reduction of clinical symptoms is not steroid controlled. DMARD therapy should end at least 6 months prior to conception.