McConkey B
Priory Hospital, Birmingham, UK.
Curr Opin Rheumatol. 1991 Jun;3(3):348-54. doi: 10.1097/00002281-199106000-00004.
In the assessment of the effects of disease-modifying antirheumatic drugs, three or four clinical measurements supported by the erythrocyte sedimentation rate, and sometimes radiographs, are generally agreed to be correct. Some advocate functional assessments also, or even alternatively. Several studies compared gold, penicillamine, antimalarials, and sulfasalazine either with each other or with placebo, and occasionally with methotrexate. No important differences between the general performance of the four drugs were found. More work was reported on sulfasalazine than on the other three drugs; the data support that it has a place in our armamentarium. Several important contributions concerned strategies of treatment. It is considered that disease-modifying antirheumatic drugs should be used earlier and more aggressively in rheumatoid arthritis. This aspect was perhaps the key note of the 1990 literature on this topic. As part of the new strategies, combination therapy is urged by some rheumatologists, whereas others urge caution on the grounds that we do not yet know enough about the effects of combinations, or by how much the risks of adverse effects are increased in combination.
在评估改善病情抗风湿药物的效果时，通常认为由红细胞沉降率支持的三项或四项临床指标，有时还包括X光片，是正确的。一些人也主张进行功能评估，甚至可以替代临床指标评估。有几项研究将金制剂、青霉胺、抗疟药和柳氮磺胺吡啶相互比较，或与安慰剂比较，偶尔也与甲氨蝶呤比较。结果发现这四种药物的总体疗效没有显著差异。关于柳氮磺胺吡啶的研究报告比其他三种药物更多；数据表明它在我们的药物库中有一席之地。有几项重要的研究涉及治疗策略。人们认为，改善病情抗风湿药物在类风湿关节炎中应更早、更积极地使用。这一点可能是1990年关于该主题文献的关键要点。作为新策略的一部分，一些风湿病学家主张联合治疗，而另一些人则主张谨慎，理由是我们对联合用药的效果了解还不够，也不清楚联合用药会使不良反应风险增加多少。
