Antirheumatic drugs: clinical pharmacology and therapeutic use.

With the exception of the treatment of gout and bacterial infections of joints, therapy in the rheumatic diseases remains inadequate. Although many patients gain symptomatic improvement on the drugs currently available, their impact on the underlying disease process remains uncertain. Hope for future therapeutic development is highest in rheumatoid arthritis with the second-line agents (e.g. gold, penicillamine), as unravelling their mechanism of action may lead to the design of more effective and less toxic medications. The cytotoxic agents appear to hold some promise in the therapy of vasculitis, but problems with their use have by no means been solved. In the major problem area of osteoarthritis, important gains are being made in the field of joint replacement, and the use of non-steroidal anti-inflammatory drugs in the interim has made symptoms more tolerable. Obviously much remains to be done in research in the area of antirheumatic drugs.