Rheumatoid arthritis (RA) is a systemic inflammatory disease whose major feature is a destructive peripheral polyarthritis. In this condition simple analgesics may relieve pain while non-steroidal anti-inflammatory drugs (NSAIDs) can reduce swelling and stiffness; neither however change the activity or rate of progression of the disease.1 If these drugs fail to control symptoms, if there is radiological evidence of rapid or progressive joint damage, or if the patient has serious extra-articular manifestations of RA (e.g. lung disease, vasculitis, amyloidosis), it is usual to start a drug that might modify the disease or induce remission. This article discusses disease-modifying drugs (DMDs) and how to choose between them.
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