Should a DMARD always be included in RA patient's treatment regimen?

Question: Should a DMARD always be included in RA patient's treatment regimen?

Answer: A question often asked by the rheumatoid arthritis (RA) patient is whether they can be treated with a minimum of drug therapy, and rely more on natural treatment products and physical therapy. Unfortunately, RA is a complex systemic disease that rarely goes into spontaneous remission. Although there is no cure for the patient once the disease is established, in most cases pharmacological treatment effectively controls disease activity. In the earliest stage of illness nonsteroidal anti-inflammatory drugs (NSAIDS) and analgesic may be all that is needed for symptomatic relief. Neither, however, have any significant effect on the underlying disease, and do not prevent progression of joint destruction or organ damage. Slow acting agents are thought to have an effect on altering the progression of RA and it is felt to be extremely important to start the patient with severe or progressive disease on a disease modifying antirheumatic drug (DMARD) prior to the development of any destructive changes in bones, joints, and organ tissues. Early intervention with DMARDs are therefore highly recommended. Examples of DMARDs include antimalarial drugs, gold compounds, Penicillamine, and Sulfasalazine.(Answer provided by the late Dr. Raymond Federman, aka Dr. Bones, who passed away on September 2, 2003. The care of his patients even in retirement was always his joy.)