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BETH H. RESMAN-TARGOFF, PHARM.D., FCCP, is Clinical Professor, Department of Pharmacy, Clinical and Administrative Sciences, The University of Oklahoma College of Pharmacy, P.O. Box 26901, Oklahoma City, OK 73190 (Beth-Resman-Targoff{at}ouhsc.edu).

Purpose. This article reviews the mechanisms of action, safety, and efficacy of the nonbiologic, or traditional, disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, sulfasalazine, leflunomide, and hydroxychloroquine. It also addresses various aspects of rheumatoid arthritis (RA) clinical trials that warrant careful interpretation, including response criteria, outcomes measurements, study designs, and results of combination therapy trials. Summary. The considerable progress in the treatment of RA over the past 20 years is due in large part to a better understanding of how to use DMARDs optimally and the introduction of biologic agents. In addition to their ability to suppress inflammation, and thereby reduce symptoms of pain and stiffness, these drugs also have the potential to alter the course of RA by slowing disease progression and reducing joint damage. Conclusion. Studies have demonstrated that early treatment of RA and rapid suppression of inflammation are extremely important as they provide long-term benefits and improve the overall prognosis for patients with the disease. Index terms: Arthritis; Chondroprotective agents; Clinical studies; Combined therapy; Hydroxychloroquine; Leflunomide; Mechanism of action; Methodology; Methotrexate; Sulfasalazine; Toxicity