Reforming the pyramid. A plan for treating rheumatoid arthritis in the 1990s

Rheum Dis Clin North Am. 1989 Aug;15(3):615-9.


Standard treatment of rheumatoid arthritis as illustrated by the pyramid does not prevent joint damage in most patients. The concept that slow-acting drugs are uniquely disease modifying is not supported by experience. Disease modification correlates best with control of inflammation and this has been demonstrated with prednisone. Many medications working by different mechanisms have a partial or temporary effect on inflammation. Following the example of cancer chemotherapy, we propose the step-down bridge, a therapeutic plan in which a combination of drugs is used to control inflammation early in the disease before joints become damaged. Medications are then sequentially discontinued as inflammation remains controlled.

Publication types

  • Review

MeSH terms

  • Anti-Inflammatory Agents / administration & dosage
  • Anti-Inflammatory Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Forecasting
  • Humans
  • Patient Care Planning / trends*
  • Synovitis / drug therapy


  • Anti-Inflammatory Agents