The systematic study of drug therapy in rheumatoid arthritis.

Important advances in therapeutics for rheumatoid arthritis (RA) will probably require coordination of the experience with new developing agents with an ongoing program of systematically collected open data, and formal controlled clinical trials to address key problematic issues. Controlled trials, despite formidable obstacles, not the least of which is the lack of satisfactory end points, are necessary because randomized treatment assignment is the only valid way to obtain results with a defined degree of certainty. A formal test of whether early aggressive intervention can arrest disease appears feasible. On the other hand, it does not now seem desirable to pursue a controlled, blinded study of RA over the longterm.