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• W4243075642 abstract "After reading Gabriel and Luthra's review of the long-term outcome of rheumatoid arthritis (RA) in the January 1988 issue of the Proceedings (pages 58 to 68), I wish to comment on the following points. The discussion about cytotoxic or immunosuppressive drugs for the treatment of RA is superficial and inaccurate. The authors cite a general reference pertaining to the use of these drugs,1Fauci AS Cytotoxic and other immunoregulatory agents.in: Kelley WN Harris Jr, ED Ruddy S Sledge CB Second edition. Textbook of Rheumatology. Vol 1. WB Saunders Company, Philadelphia1985: 833-857Google Scholar and the discussion is limited to the use of cyclophosphamide. No mention is made of the role of azathioprine,2Urowitz MB Immunosuppressive therapy in rheumatoid arthritis.J Rheumatol. 1974; 1: 364-373Google Scholar the in-vogue use of methotrexate,3Nordstrom DM West SG Andersen PA Sharp JT Pulse methotrexate therapy in rheumatoid arthritis: a controlled prospective roentgenographic study.Ann Intern Med. 1987; 107: 797-801Crossref PubMed Scopus (63) Google Scholar, 4Kremer JM Lee JK The safety and efficacy of the use of methotrexate in long-term therapy for rheumatoid arthritis.Arthritis Rheum. 1986; 29: 822-831Crossref PubMed Scopus (329) Google Scholar and the controversial use of lymphoid irradiation in intractable RA.5Hanly JG Hassan J Moriarty M Barry C Molony J Casey E Whelan A Feighery C Bresnihan B Lymphoid irradiation in intractable rheumatoid arthritis: a double-blind, randomized study comparing 750-rad treatment with 2,000-rad treatment.Arthritis Rheum. 1986; 29: 16-25Crossref PubMed Scopus (28) Google Scholar These agents have a role in the treatment of RA and should have been analyzed more deeply in a subject review dealing with the long-term outcome of RA. The authors state that these compounds have generally been reserved for patients in whom therapy with two or more sequential drugs have failed. As far as I know, combined therapy for RA is, in general, the “last choice,”6McCarty DJ Carrera GF Intractable rheumatoid arthritis: treatment with combined cyclophosphamide, azathioprine, and hydroxychloroquine.JAMA. 1982; 248: 1718-1723Crossref PubMed Scopus (110) Google Scholar and today's rheumatologists prefer to use immunosuppressive drugs earlier than in the past. Finally, the discussion (especially point 1) seems to imply that, teleologically, it is senseless to treat patients with RA. It seems difficult to accept such an idea in light of the above-cited studies (to quote only a few of them). If the patients of the 1940s or 1950s could be compared with the patients of this decade, I am positive that a vast difference would be noted. Rheumatoid Arthritis: The authors replyMayo Clinic ProceedingsVol. 63Issue 8PreviewWe appreciate Dr. Kraus' comments and, in reply, would like to state that our review was not intended to be an exhaustive study of the treatment of rheumatoid arthritis (RA) but was intended to raise the question about whether treatment is actually altering the long-term outcome of the disease. Dr. Kraus contends that immunosuppressive agents should have been discussed in more detail. Unfortunately, sparse data are available about the long-term outcome of RA with the use of these agents. Hunter and associates1 reported on the use of azathioprine in 17 patients (5 of whom were also receiving prednisone) who had long-term follow-up. Full-Text PDF" @default.
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• W4243075642 date "1988-08-01" @default.
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• W4243075642 title "Rheumatoid Arthritis" @default.
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• W4243075642 doi "https://doi.org/10.1016/s0025-6196(12)62369-6" @default.
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