Drug of choice for NSAID resistant Rheumatoid Arthritis

(A) Methotrrexate # Usual approach to Rheumatoid Arthritis: is to attempt to alleviate the patient's symptoms with NSAIDs or Coxibs. Some patients may have mild disease that requires no additional therapy. However, if the patient has any evidence of aggressive disease, initiation of DMARD therapy should be considered as early as feasible. This group of agents includes methotrexate, gold compounds.D-penicillamine, the antimalarials, and sulfasalazine. Despite having no chemical or pharmacologic similarities, in practice these agents share a number of characteristics Methotrexate has emerged as the DMARD of choice because of its relatively rapid onset of action, its capacity to elfect sustained improvement with ongoing therapy, and the higher level of patient retention on therapy.