Role of disease-modifying antirheumatic drugs versus cytotoxic agents in the therapy of XXXX .

@entity1 @entity137 @entity500 @entity786 @entity2361 @entity12299 @entity6383 @entity158 @entity1499 @entity309
Disease-modifying antirheumatic drugs are used to modify or alter the @entity309 process. Disease-modifying antirheumatic drugs do not demonstrate the characteristic analgesic, antipyretic, and anti-inflammatory actions of the nonsteroidal anti-inflammatory drugs, since weeks or months of treatment are required before clinical benefit is observed. Although they have not been proved to delay, prevent, or reverse articular damage, therapy with disease-modifying antirheumatic drugs, when successful, is associated with @entity158 and improved function. Disease-modifying antirheumatic drugs and cytotoxic agents should not be considered as routine treatment for @entity1 with @entity309 . Before disease-modifying antirheumatic drug therapy is implemented, an optimal basic program of physical therapy, rest, and nonsteroidal anti-inflammatory drugs should be implemented, and it must be documented that the @entity1 still has sufficient disease to justify the costs, risks, and benefits of these treatments. Drugs that are approved by the Food and Drug Administration (FDA) are preferred over nonapproved drugs. @entity6383 , parenteral gold salts, oral gold, @entity2361 , and the cytotoxic drug @entity500 are the FDA-approved disease-modifying antirheumatic drugs for use in @entity309 . Many, not all, rheumatologists would employ @entity6383 as the first-choice disease-modifying antirheumatic drug in @entity1 who have early, mild, and nonerosive disease; treatment should be continued for six months before being abandoned for lack of efficacy, and appropriate ophthalmologic examination every four to six months is indicated. An alternative would be auranofin, whose efficacy approaches that of parenteral gold, yet may be safer. For @entity1 who have severe active @entity309 , especially with erosive changes, parenteral gold salts are usually a first choice. @entity2361 is also effective in controlling the signs and symptoms of @entity309 , but serious @entity137 may occur. @entity500 might be considered a competitor to @entity2361 , although the FDA approval restricts its use to @entity1 who have failed gold therapy. Two cytotoxic drugs that are not FDA approved are @entity1499 and @entity786 . @entity1499 can be very effective, but its side effects, particularly pulmonary and hepatic, must be carefully monitored. @entity786 is generally considered too toxic for use in @entity1 with @entity309 , although it may be helpful in @entity1 with @entity12299 or @entity1 who have failed all other therapies.(ABSTRACT TRUNCATED AT 400 WORDS)
