V. Chemotherapy in Rheumatoid Arthritis: A Concept

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RHEUMATOID ARTHRITIS is a variable and unstable disease that disappears spontaneously or responds quickly to nonspecific measures in approximately half of the patients seeking medical care.46 In the patients in whom the disease does not respond satisfactorily to simple measures, treatment becomes difficult, and in approximately one third of those patients the disease may become so intractable as to defy almost any method of therapy.

To be completely efficacious in the treatment of rheumatoid arthritis, a therapeutic agent must be nontoxic and able quickly to suppress the acute phase of the disease, to elevate mood or to counteract emotional instability when present, to prevent relapses, and constantly to suppress chronically active disease associated with persistent inflammatory joint manifestations, while permitting the maintenance of useful activity. Unfortunately, no single therapeutic agent, or, heretofore, any combination of agents has been capable of fulfilling all of these criteria. We believe that our present therapeutic program comes closer to the ideal than any therapy that we have used previously. Inasmuch as each of the drugs that have been used possesses a different pharmacologic action, it appeared logical that results could be improved and the danger of toxicity could be reduced by administering a combination of drugs each in a dose smaller than that which ordinarily would be used if the drug were employed alone. An exception was the antimalarial agents (hydroxychloroquine sulfate and chloro-quine phosphate), the dosage of which was not reduced since they rarely cause toxic reactions.

Our program of therapy for patients . . .



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