Therapeutic approach in rheumatology: NSAID, corticosteroid, disease modifying drugs (DMARD): conventional synthetic, biological and targeted synthetic DMARDs
1. Big picture
Rheumatologic therapy has two different goals:
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Control symptoms quickly → non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, local/intra-articular corticosteroids, short systemic corticosteroids.
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Stop immune-mediated damage and prevent disability → disease-modifying antirheumatic drugs (DMARDs).
The key exam logic is:
NSAIDs and corticosteroids reduce inflammation and pain, but they usually do not prevent structural progression. DMARDs modify the disease course.
In rheumatoid arthritis (RA), modern treatment follows a treat-to-target strategy: start DMARDs early, reassess regularly, and aim for remission or low disease activity. Methotrexate is the anchor first-line conventional synthetic DMARD in RA if not contraindicated. ([Annals of the Rheumatic Diseases][1])
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