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Rheumatology 2002; 41: 1346-1356
© 2002 British Society for Rheumatology


Review

Evidence from clinical trials and long-term observational studies that disease-modifying anti-rheumatic drugs slow radiographic progression in rheumatoid arthritis: updating a 1983 review

T. Pincus1,, G. Ferraccioli2, T. Sokka1,,3, A. Larsen4, R. Rau5, I. Kushner6 and F. Wolfe7

1 Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University School of Medicine, 203 Oxford House, Nashville, TN 37232-4500, USA,
2 Division of Rheumatology, Department of Internal Medicine, DPMSC, School of Medicine of Udine, 33100 Udine, Italy,
3 Jyvaskyla Central Hospital, 40620 Jyvaskyla, Finland,
4 Rheumatology Department, Kongsvinger Sjukehus, N-2226 Kongsvinger, Norway,
5 Evangelisches Fachkrankenhaus, Rheumaklinik, Rosenstrasse 2, D-40882 Ratingen, Germany,
6 Division of Rheumatology, Case Western Reserve University, MetroHealth Medical Center Campus, 2500 MetroHealth Drive, Cleveland, OH 44109-1998 and
7 Wichita Arthritis Center, 1035 North Emporia, #230, Wichita, KS 67214, USA

Earlier reports, including a comprehensive 1983 review, had indicated that slowing of radiographic progression was relatively unusual in treatment of rheumatoid arthritis (RA) using traditional disease modifying anti-rheumatic drugs. However, in recent years, slowing of radiographic progression has been documented in a number of clinical trials, as well as long-term observational studies, with use of (in alphabetical order) adalimumab, anakinra, corticosteroids, cyclophosphamide, cyclosporin, etanercept, gold salts, infliximab, leflunomide, methotrexate and sulphasalazine. At this time, disease modification is a realistic goal in the clinical care of patients with RA. Documentation of improved long-term outcomes requires long-term observational data over 5–20 yr to supplement data from randomized controlled clinical trials over 6–24 months.

Correspondence to: T. Pincus, Vanderbilt University School of Medicine, Division of Rheumatology and Immunology, 203 Oxford House, Nashville, TN 37232, USA.


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