The earliest treatments of rheumatoid arthritis are mainly directed against the symptoms of the disease and are generally aimed at maintaining the patient's quality of life. The drugs used are often non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen and the cyclooxygenase 2 (COX2) inhibitors, all of which reduce pain and inflammation. NSAIDs are often used together with steroids (gluco-cortocoids), which together offer a very potent short-term anti-inflammatory effect.
Development of new treatments of RA has lead to the development of treatments that are directed more against the mechanism of the disease. These treatments not only aim at relieving the symptoms but also to stop the progression of the disease, and also if possible, revert the destruction of the involved cartilage joints. These treatments are collectively named disease modifying antirheumatic drugs (DMARDs). The most popular DMARD is methotrexate (MTX), a folic acid antagonist originally used for the treatment of cancer. Other DMARDs include sul-phasalazine, tetracyclines and cyclosporine. Based on long-time use and positive outcome of treatments, MTX has generally been accepted as the leading DMARD [4, 5]. Although being an effective drug, about 50% of patients fail treatment due to side effects and loss of efficacy.
Hence, development of more potent drugs with similar mechanism as MTX, like leflonomide, has been approved for treatment of RA patients. However, there is still a large fraction of the RA patient group that do not get any symptom relief from these treatments.
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