Reclassification of Antirheumatic Agents: How and Why?

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Abstract

Summary

A proposed new classification of antirheumatic therapy nominates two major categories, as follows.

1. Symptom-modifying antirheumatic drugs (SM-ARDs) improve the symptoms and clinical features of inflammatory synovitis. They can be further categorised as: (I) nonsteroidal anti-inflammatory drugs; (II) corticosteroids; and (III) slower-acting drugs, e.g. antimalarials, gold, penicillamine, antimetabolites and cytotoxic agents.

2. Disease-controlling antirheumatic therapy (DC-ART) changes the course of rheumatoid arthritis. These agents (a) improve and sustain function in association with decreased inflammatory synovitis, and (b) prevent structural joint damage, or significantly decrease its rate of progression. Changes must be sustained for a minimum period of 1 year. The classification must include reference to the time for which criteria have been satisfied, e.g. a 2-year DC-ART.

All currently available therapeutic agents are SM-ARDs. DC-ARTs are a new group and a new concept. The development of therapies in this category represents a major challenge to drug developers.

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