[Drug therapy of rheumatoid arthritis]

Continuous, computer-aided registration of large numbers of patients with rheumatoid arthritis (RA) had lead to a revised concept of the prognosis. More patients than previously throught develop severe progressive, erosive, deforming, and crippling disease. Most of the permanent damage develops within the first 10 years of the course of the disease. The patients die 10-15 years before the background population, even though the cause of death is rarely a direct consequence of the disease. Because of these observations, the treatment strategy is now becoming more aggressive than previously. Treatment with slow acting anti-rheumatic drugs (SAARDs) is started within the first year. Synovitis activity is monitored continuously, and in case of primary or secondary resistance to one SAARD the drug is replaced by another one for as long as the disease is active. This procedure makes it necessary that all patients with suspected RA be evaluated early and repeatedly by rheumatologists during the whole course of the disease. The drug treatment should be conducted with close cooperation between the general practitioners and the rheumatologists.