The problems of studying disease-remittive agents in RA

Problems in trials of disease-remittive agents include the slow action and late side effects of these compounds, the lack of immediate benefit to the patient, their characteristic and sometimes dangerous side effects, variability of response, natural fluctuation of the disease, and uncertain definition of drug types. To overcome these problems, trials must be of long duration with large numbers of patients whose characteristics are clearly defined. The 2/3 blind technique overcomes the problem of side effects. Measurements must include aspects of the disease state as well as its articular manifestations. Criteria for the identification of disease-remittive agents include effects in animal models of inflammation, time course, disease-dependence, effects on joint disease and extraarticular manifestations, changes in erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and immunoglobulins, radiological progression, outcome, and perhaps side effects. The time course of the action of auranofin (AF), similar to that of Myochrysine, with its effects on ESR and RF, support the view that AF is a disease-remittive agent.