Anastassiades T P
Can Med Assoc J. 1980 Feb 23;122(4):405-15.
The administration of certain drugs to patients with established rheumatoid arthritis frequently results in improvement that is slow to appear but persists for long periods, even after the drug is discontinued. The three main drugs with this effect, whose efficacy and toxicity are reviewed in this paper, are gold salts, D-penicillamine and chloroquine. The cytotoxic agents used to treat rheumatoid arthritis, which likely have nonspecific anti-inflammatory actions and have serious long-term side effects, are also briefly reviewed. A new drug, levamisole, is currently being tested in patients with rheumatoid arthritis. It is suggested that the time for considering the introduction of a remission-inducing drug in patients with progressive rheumatoid arthritis is after an adequate trial of therapy with salicylates or other nonsteroidal anti-inflammatory agents, or both, and before the oral administration of steroids. It is difficult, however, on the basis of rigorous clinical comparisons, to recommend which of the three main remission-inducing drugs should be tried first, although gold salts have been used the most. Patients who have improved with 6 months of chrysotherapy may continue treatment for at least 3 years, during which time the frequency of mucocutaneous and renal toxic effects will steadily decrease. Some aspects of the medical economics of therapy with remission-inducing drugs for rheumatoid arthritis are discussed.
对确诊为类风湿性关节炎的患者使用某些药物，常常会出现起效缓慢但持续时间长的改善效果，即便停药后亦是如此。本文将对具有这种效果的三种主要药物（金盐、D-青霉胺和氯喹）的疗效及毒性进行综述。用于治疗类风湿性关节炎的细胞毒性药物可能具有非特异性抗炎作用，但有严重的长期副作用，本文也将对其进行简要综述。一种新药左旋咪唑目前正在类风湿性关节炎患者中进行试验。有人提出，对于病情进展的类风湿性关节炎患者，考虑引入诱导缓解药物的时机是在充分试用了水杨酸类药物或其他非甾体抗炎药或两者之后，且在口服类固醇之前。然而，基于严格的临床比较，很难推荐三种主要诱导缓解药物中应首先试用哪一种，尽管金盐使用得最为广泛。接受金疗法6个月后病情有所改善的患者可继续治疗至少3年，在此期间，皮肤黏膜和肾脏毒性反应的发生率会稳步下降。本文还讨论了类风湿性关节炎诱导缓解药物治疗的医学经济学的一些方面。
