Evens R P
Am J Hosp Pharm. 1979 May;36(5):622-33.
The pathophysiology, symptoms and drug treatment of rheumatic disease are reviewed. Antirheumatic drugs reviewed are salicylates (including aspirin, sodium salicylate, choline salicylate, choline magnesium salicylate, salsalate), phenylpropionic acid derivatives (fenoprofen, ibuprofen, naproxen), indole derivatives (sulindac, tolmetin and indomethacin), pyrazolone derivatives (phenylbutazone, oxyphenbutazone), gold compounds, penicillamine, antimalarials mefenamic acid, corticosteroids and immunosuppressives. Simple analgesic therapy (acetaminophen, aspirin, propoxyphene) is used in the early stage of the disease. As the disease progresses, aspirin remains the drug of choice for antiinflammatory activity but the phenylpropionic acid or indole derivatives may be preferred in patients unable to tolerate salicylates. If such nonsteroidal antiinflammatory agents are not effective, parenteral therapy with gold compounds or oral penicillamine usually is indicated. Indomethacin or phenylbutazone, then antimalarials, are resorted to next. Corticosteroids or immunosuppressives are reserved for patients who are unsuccessfully controlled or who have major side effects with the other drugs. Mefenamic acid occupies a very secondary place in rheumatoid arthritis treatment.
本文综述了风湿性疾病的病理生理学、症状及药物治疗。所综述的抗风湿药物包括水杨酸盐类（包括阿司匹林、水杨酸钠、胆碱水杨酸盐、胆碱镁水杨酸盐、双水杨酸酯）、苯丙酸衍生物（非诺洛芬、布洛芬、萘普生）、吲哚衍生物（舒林酸、托美丁、吲哚美辛）、吡唑酮衍生物（保泰松、羟基保泰松）、金化合物、青霉胺、抗疟药甲芬那酸、皮质类固醇及免疫抑制剂。在疾病早期使用简单的镇痛疗法（对乙酰氨基酚、阿司匹林、丙氧芬）。随着疾病进展，阿司匹林仍是抗炎活性的首选药物，但对于不能耐受水杨酸盐的患者，苯丙酸或吲哚衍生物可能更受青睐。如果此类非甾体抗炎药无效，通常需采用金化合物的胃肠外治疗或口服青霉胺。接下来可使用吲哚美辛或保泰松，然后是抗疟药。皮质类固醇或免疫抑制剂则用于那些用其他药物治疗效果不佳或出现严重副作用的患者。甲芬那酸在类风湿性关节炎治疗中处于非常次要的地位。
