Effectiveness and toxicity considerations in outcome directed therapy in rheumatoid arthritis

J Rheumatol Suppl. 1996 Mar;44:102-6.


New paradigms of disease modifying antirheumatic drug based treatment strategies for rheumatoid arthritis (RA) raise new questions of sequencing of medications and employment of combination therapy. A broader view of chronic illness indicates that nonbiologic and self-management factors influence disease course and necessitate inclusion of patient oriented outcome measures such as disability and pain. I discuss these and related issues, present a broad model of disease progression in RA, introduce the concept of the "therapeutic segment," describe the dependence of clinical results on immediately prior therapy, and suggest a new research approach into the merits of combination therapy. Effectiveness is not necessarily increased by addition of a 2nd drug, nor is toxicity necessarily increased by combination therapy.

Publication types

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

MeSH terms

  • Antirheumatic Agents / adverse effects*
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Disease Progression
  • Drug Therapy, Combination
  • Humans
  • Models, Theoretical
  • Treatment Outcome


  • Antirheumatic Agents