Pharmacological control of inflammatory connective tissue diseases

The primary cause of the most common inflammatory rheumatic diseases in unknown. Microbial infection combined with an increased susceptibility due to genetically determined alterations in the immune system is probably of importance. Non-specific processes of inflammation and repair are the immediate causes of the clinical symptoms, and anti-inflammatory therapy is at present the corner stone in the control of these diseases. The highest priority in research should be given to drugs, which in controlled clinical trials have demonstrated ability to cause remission of disease activity. Important examples are D-penicillamine, glucocorticoids and the cytostatic drugs. The effects of these drugs on the metabolism of proteoglycans and collagen in granulation tissue and normal connective tissue may explain some of the beneficial effects, but also some of the side effects. Rational pharmacotherapy in the inflammatory rheumatic diseases may be a combination of anti-inflammatory drugs with immunotherapy and possibly antimicrobial therapy.