ABSTRACT
Successful, longterm pharmacologic management of rheumatic diseases has been an elusive goal for physicians caring for individuals with these chronic disorders. Pharmacologic antirheumatic therapy has been developed traditionally through empiric channels. The beneficial effect of gold salts in rheumatoid arthritis was noted initially when disease-modifying agent was administered as antimicrobial therapy because of its use in tuberculosis and the belief that rheumatoid arthritis was caused by an infectious agent. Rheumatoid arthritis is the prototypic inflammatory joint disease characterized by immunogenetic susceptibility, by profound abnormalities of humoral and cell-mediated immunity, by immunologically driven chronic synovitis, and by variable clinical expression, including the potential for joint destruction and for significant extra-articular manifestations. The use of traditional “disease-modifying” antirheumatic drugs or second-line agents has been based almost totally on empiricism, and the exact mechanism of action of most agents in this category remains obscure.
