Therapeutic ReviewOld and New Drugs Used in Rheumatoid Arthritis: A Historical Perspective Part 1: The Older DrugsCase, John P.Author Information Division of Rheumatology, Cook County Hospital, and Section of Rheumatology, Rush Medical College, Chicago, IL. Address for correspondence: Section of Rheumatology, 1725 West Harrison Street, Suite 1017, Chicago, IL 60612, USA. American Journal of Therapeutics: March 2001 - Volume 8 - Issue 2 - p 123-143 Buy Abstract Rheumatoid arthritis is the paradigmatic immune-mediated inflammatory arthropathy and may be of comparatively recent, New World origin. Apart from the symptom-relieving nonsteroidal anti-inflammatory drugs, whose natural congeners have been in use since antiquity for musculoskeletal pain and inflammation, only a dozen drugs or drug classes—the disease-modifying antirheumatic drugs—are currently in common use in rheumatoid arthritis. Development of these drugs has been a notable achievement of the 20th century. Some were developed serendipitously (glucocorticoids, antimalarials), some were the product of faulty reasoning (gold, D-penicillamine), and others were applied for plausible reasons but whose mechanism remains unproven (sulfasalazine, methotrexate, minocycline). A minority were originally applied on the basis of actions that remain germane to the pathophysiology of rheumatoid arthritis as currently understood (azathioprine, cyclosporine, leflunomide, infliximab, etanercept). Among the latter are the more recently introduced and effective agents. The practical use of these drugs is determined by efficacy–toxicity considerations, which have also driven the recent development of the cyclooxygenase-2–selective nonsteroidal anti-inflammatory drugs. © 2001 Lippincott Williams & Wilkins, Inc.