Efficacy of standard slow-acting antirheumatic drugs

There are few published reports of the efficacy of slow-acting antirheumatic drugs (SAARDs) specific to the treatment of persons with early rheumatoid arthritis. Two published meta-analyses of the literature on SAARD therapy are reviewed, together with some empirical data on patients with less than 2 years' disease duration treated over an 8-year period. Although the literature suggests short-term benefit of SAARDs compared with placebo therapy, there is little to warrant considering presently available drugs to be disease-remittive agents. Based on known toxicities and purported benefits of available SAARDs, a treatment schema is proposed that responds incrementally to the course of the illness when treatment is started before irreversible joint injury occurs. The advent of new classes of therapeutic agents (eg, biologicals) for the treatment of rheumatoid arthritis warrants examination of present methods for the evaluation of antirheumatic drugs.