Anti-rheumatic drugs and joint damage in rheumatoid arthritis.

The effect of second-line anti-rheumatic drugs such as gold on the course and progression of joint damage has been the subject of considerable controversy. We have evaluated the effects of second-line anti-rheumatic drugs in three studies of 46-84 patients with rheumatoid arthritis given a second-line drug continuously for 12 months. Using two different methods of radiographic assessment we found that there was significant progression over the 12-month period when the mean changes in the groups of patients were examined, and there was similar indications of continuing disease activity shown by mean values of acute phase proteins and ESR which were above the normal range at both six and 12 months. But there were subgroups of patients who showed a reduction in ESR and joint tenderness with a related slowing of the rate of radiographic progression in the second six months of treatment. There was no direct relationship between changes in the ESR and radiographic progression in individual patients. Although anti-rheumatic drugs are not ideal and therapy does not cause remission in many patients, some patients respond well. Rheumatoid arthritis may represent a heterogeneous collection of patients who respond individually to different drugs.