Denman A M
Ann Rheum Dis. 1982;41 Suppl 1(Suppl 1):3-8. doi: 10.1136/ard.41.suppl_1.3.
Ignorance of the basic nature of rheumatoid arthritis precludes the introduction of rational schemes for using cytotoxic drugs. It is still plausible that the autoimmune and other immunological abnormalities which accompany this disease are the secondary effects of persistent antigen, for example, related to microbial infections. In this event, cytotoxic drugs may diminish the inflammatory response but their effects on immune responses would be irrelevant or even undesirable. Should rheumatoid arthritis prove to be a primary immunoproliferative disorder, cytotoxic drugs may prove to be of value not because of their conventional immunosuppressive effects but because of their selective action on the proliferating cells. Indeed, current evidence suggests that these drugs enhance rather than depress conventional immune responses, at least in the doses given to patients with rheumatic disorders.
对类风湿性关节炎基本性质的无知妨碍了合理使用细胞毒性药物方案的引入。这种疾病伴随的自身免疫和其他免疫异常仍是持续抗原的继发效应，例如与微生物感染有关，这一观点仍有其合理性。在这种情况下，细胞毒性药物可能会减轻炎症反应，但它们对免疫反应的影响将是无关紧要的，甚至是不理想的。如果类风湿性关节炎被证明是一种原发性免疫增殖性疾病，细胞毒性药物可能会被证明是有价值的，这并非因为它们传统的免疫抑制作用，而是因为它们对增殖细胞的选择性作用。事实上，目前的证据表明，至少在给予风湿性疾病患者的剂量下，这些药物增强而非抑制传统免疫反应。
