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Conventional DMARDs are known to be the first-line treatment for rheumatoid arthritis. [9] Treatment can be a monotherapy or in combination with other anti-arthritic medications. Common DMARDs include oral methotrexate, leflunomide, or sulfasalazine. Conventional DMARDs have a slow onset of action and can take 2–3 months to exhibit effect. [9]
When treatment with DMARDs fails, cyclophosphamide or steroid pulse therapy is often used to stabilise uncontrolled autoimmune disease. Some severe autoimmune diseases are being treated with bone marrow transplants in clinical trials, usually after cyclophosphamide therapy has failed.
Methotrexate pneumonitis is a rare complication of therapy and appears to be reducing in frequency in most recent rheumatoid arthritis treatment trials. [41] In the context of rheumatoid arthritis interstitial lung disease, methotrexate treatment may be associated with a lower incidence of ILD over time. [citation needed]
Agents may be used in combination, however, people may experience greater side effects. [8] [122] Methotrexate is the most important and useful DMARD and is usually the first treatment. [8] [5] [123] A combined approach with methotrexate and biologics improves ACR50, HAQ scores and RA remission rates.
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The use of injected gold compound is indicated for rheumatoid arthritis. [4] Its uses have diminished with the advent of newer compounds such as methotrexate and because of numerous side effects. [4] The efficacy of orally administered gold is more limited than injecting the gold compounds. [5]