Therapeutic Strategies

THERAPEUTIC STRATEGIES

The treatment of patients with inflammation involves two pri-mary goals: first, the relief of symptoms and the maintenance of function, which are usually the major continuing complaints of the patient; and second, the slowing or arrest of the tissue-damaging process. In rheumatoid arthritis, response to therapy can be quantitated using several measures such as the Disease Activity Scale (DAS), the Clinical Disease Activity Index (CDAI), and the American College of Rheumatology Response index (ACR Response). The first two are continuous variables denoting both state and change, while the latter is solely a change measure. In the latter, the scoring values of ACR20, ACR50, and ACR70 denote the percentage of patients showing an improvement of 20%, 50%, or 70%, respectively, in a global assessment of signs and symptoms.

Reduction of inflammation with nonsteroidal anti-inflammatory drugs (NSAIDs) often results in relief of pain forsignificant periods. Furthermore, most of the nonopioid analgesics (aspirin, etc) have anti-inflammatory effects, so they are appropri-ate for the treatment of both acute and chronic inflammatory conditions.The glucocorticoids also have powerful anti-inflammatory effects and when first introduced were considered to be the ulti-mate answer to the treatment of inflammatory arthritis. Although there are data that low-dose corticosteroids have disease-modifying properties, their toxicity makes them less favored than other medications, when it is possible to use the others. However, the glucocorticoids continue to have a significant role in the long-term treatment of arthritis.

Another important group of agents is characterized as disease-modifying antirheumatic drugs (DMARDs) and biologics (asubset of the DMARDs). They decrease inflammation, improve symptoms, and slow the bone damage associated with rheuma-toid arthritis. They affect more basic inflammatory mechanisms than do glucocorticoids or the NSAIDs. They may also be more toxic than those alternative medications.