Drug therapy for the rheumatoid patient—the selection of an agent and course of treatment—is often a difficult and frustrating task for the physician.
"Nowhere have the problems involved in the selection of a therapeutic agent been more apparent than in the chronic rheumatoid disorders," said Nathan J. Zvaifler, MD. "Lacking a definite etiology, their therapy has frequently been pragmatic or symptomatic."
Added to the unpredictable and varying course of disease is a further complication arising from the nature of the available therapeutic agents: virtually every drug useful in treatment of rheumatoid disease is potentially toxic.
These toxic effects include gastrointestinal bleeding from salicylates, renal papillary necrosis from phenacetin, blood dyscrasias and peptic ulcers from phenylbutazone, dermatitis and renal complications from gold salts, retinal damage from the antimalarials, purpura, peptic ulcer and osteoporosis from corticosteroids, and gastrointestinal and cerebral complications from the use of indomethacin.Improvement is possible in