Safety issues related to DMARD therapy

J Rheumatol Suppl. 1990 Nov;25:14-7.


The old pyramidal approach to treatment of rheumatoid arthritis depended most fundamentally upon the beliefs that the most effective agents were also the most toxic, that toxic-therapeutic ratios of different drug categories were about the same, and that one should first use the least effective and least toxic drugs. Recent data, however, demonstrate the often severe toxicity of the nonsteroidal antiinflammatory drugs and the surprisingly good safety record of certain disease modifying antirheumatic drugs. New analyses tend, in general, to support less aggressive monitoring strategies. Some of the fundamental assumptions of the old pyramidal strategy are shown to have been inaccurate.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Inflammatory Agents / adverse effects*
  • Anti-Inflammatory Agents / therapeutic use
  • Anti-Inflammatory Agents / toxicity
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Arthritis, Rheumatoid / drug therapy*
  • Humans
  • Information Systems
  • Product Surveillance, Postmarketing / economics
  • Product Surveillance, Postmarketing / methods


  • Anti-Inflammatory Agents
  • Anti-Inflammatory Agents, Non-Steroidal