Challenging the pyramid. A new look at terapeutic approaches for rheumatoid arthritis. Patient selection.

The goals of therapy for rheumatoid arthritis (RA) address alleviation of pain; prevention of joint destruction, deformity, and disability; and maintenance of life style. Disease modifying antirheumatic drugs (DMARD) are among the most important agents to accomplish these goals, but guidelines for their introduction into management have not been clearly established. In 1986 a survey regarding DMARD usage was conducted among 1057 specialists in arthritis. The key criteria used in patient selection were progressive pattern of disease, persistent synovitis, and the degree of swollen joints. Eighty-four percent of respondents waited 3 to 6 months from the time of initial diagnosis of RA before starting DMARD. Parenteral gold was then the most preferred DMARD.