Table Of ContentTherapeutics in
Rheumatology
Therapeutics in
Rheumatology
Edited by
J. M. H. MOLL
BSc DM PhD FRCP
Consultant physician in Rheumatology and Head, Sheffield Centre for Rheumatic
Diseases, Nether Edge Hospital, Sheffield; Honorary Clinical Lecturer in Rheumatic
Diseases, University of Sheffield.
H. A. BIRD
MAMDFRCP
Lecturer in Rheumatology, University Department of Medicine, General Infirmary
at Leeds; Honorary Consultant Rheumatologist, General Infirmary at Leeds, and
Royal Bath Hospital, Harrogate.
A. RUSHTON
MBChBMRCP
Drug team leader, Clinical Research Department, Imperial Chemical Industries PLC,
Pharmaceuticals Division, Alderley Park, Macclesfield.
Springer-Science+Business Media, B.V.
© 1986 J. M. H. Moll, H. A. Bird and A. Rushton
Originally published by Chapman and Hall in 1986.
University Press, Cambridge
All rights reserved. No part of this book may be reprinted, or
reproduced or utilized in any form or by any electronic,
mechanical or other means, now known or hereafter invented,
including photocopying and recording, or in any information
storage and retrieval system, without permission in writing
from the publisher.
British Library Cataloguing in Publication Data
Therapeutics in rheumatology.
1. Rheumatism-Chemotherapy
I. Moll, J. M.H. II. Bird,
H.A. III. Rushton, A.
616.7'23061 RC927
ISBN 978-0-412-24540-4 ISBN 978-1-4899-2883-2 (eBook)
DOI 10.1007/978-1-4899-2883-2
Softcover reprint of the hardcover 1st edition 1986
Contents
Contributors page vii
Preface x
Acknowledgements Xll
Note on limited list prescribing in the UK Xlll
Antirheumatic agents recently withdrawn (or restricted)
in UK XIV
SECTION I
Pharmacological and therapeutic principles
Introduction to Section I 1
1. The pharmacological basis of antirheumatic drug
therapy 3
2. Pharmacokinetics 49
3. Drug interactions 87
4. Adverse reactions 127
5. Evaluation of drug response 148
SECTION II
The rheumatological pharmacopoeia
Introduction to Section II 181
6. Simple analgesics and pain 183
7. Non-steroidal anti-inflammatory drugs 206
8. Corticosteroids in rheumatic diseases 242
9. Slow-acting antirheumatoid drugs 261
10. New drugs and experimental progress 295
vi Contents
SECTION III
Clinical applications and implications
Introd.uction to Section III 319
11. Rheumatoid arthritis 321
12. The spondarthritides 358
13. Osteoarthrosis, spinal degenerative disease and other
back pain syndromes 378
14. Gout and other crystal-deposition disorders 414
15. Miscellanea and rarities 441
16. Drug-induced syndromes and drug toxicity 479
International glossary of proprietary antirheumatic drugs 515
Index 541
Contributors
H. Berry Consultant in Rheumatology and Rehabilitation,
MA,DM,FRCP King's College Hospital, London, England.
H. A. Bird Senior lecturer in Rheumatology, University
MA,MD, FRCP Department of Medicine, General Infirmary at
Leeds; Honorary Consultant Rheumatologist,
General Infirmary at Leeds, and Royal Bath
Hospital, Harrogate, England.
H. A. Capell Consultant Physician, The Centre for Rheumatic
MB, BCh, FRCP Diseases, University Department of Medicine,
The Royal Infirmary, Glasgow, Scotland.
D. E. Caughey Clinical Reader in Medicine, Auckland Medical
MB, FRCP(Ed.), School; Consultant Rheumatologist, Auckland
FRACP Hospital, Auckland, New Zealand.
D. M. Grennan Consultant and Senior Lecturer, University of
MD, PhD, Manchester Rheumatic Diseases Centre, Hope
FRCP(Glasg.) Hospital, Salford, England.
N. D. Hall Lecturer in Pharmacology, University of Bath;
MA, PhD Honorary Immunologist, Royal National
Hospital for Rheumatic Diseases, Upper Borough
Walls, Bath, England.
F. D. Hart Honorary Consulting Physician, Westminster
MD, FRCP Hospital, Chelsea Hospital for Women and the
Hospital of St. John and St. Elizabeth, London,
England.
D. W. G. Harron Lecturer, Department of Therapeutics and
PhD, MPS Pharmacology, Queens University, Belfast,
Northern Ireland.
viii Contributors
I. Haslock Consultant Rheumatologist, South Tees Health
MD District, Middlesbrough General Hospital,
Middlesbrough, England.
B. L. Hazleman Consultant Rheumatologist, Director
MA,MB,FRCP Rheumatology Research Unit, Addenbrooke's
Hospital; Associate Lecturer, Cambridge
University, Cambridge, England.
Carol Higham Lecturer in Pharmacy, University of Manchester
MSc,MPS Rheumatic Diseases Centre, Hope Hospital,
Salford, England.
P. J. L. Holt Reader in Rheumatology and Physician in
MB, FRCP Charge, Rheumatism Research Centre, University
of Manchester, The Royal Infirmary; Physician,
Regional Paediatric Rheumatology Unit, Booth
Hall Children's Hospital, Manchester, England.
S. P. Liyanage Consultant Rheumatologist, Heatherwood
MB, FRCP, DCH Hospital, Ascot; King Edward VII Hospital,
Windsor; and St Mark's Hospital, Maidenhead,
England.
R. Madhok Registrar, The Centre for Rheumatic Diseases,
MB, ChB, MRCP University Department of Medicine, The Royal
Infirmary, Glasgow, Scotland.
J. M. H. Moll Consultant Physician in Rheumatology and
BSc, DM, PhD, Head, Sheffield Centre for Rheumatic Diseases,
FRCP Nether Edge Hospital, Sheffield; Honorary
Clinical Lecturer in Rheumatic Diseases,
University of Sheffield, England.
Vera C. M. Senior Registrar, Rheumatism Research Unit,
Neumann University department of Medicine, General
BA,MB, MRCP Infirmary at Leeds, England.
M. C. L'E. Orme Professor of Clinical Pharmacology, University of
MA,MD,FRCP Liverpool; Consultant Physician, Liverpool
AHA(T), Department of Pharmacology and
Therapeutics, New Medical School, Ashton
Street, Liverpool, England.
Contributors ix
A. Rushton Senior Medical Adviser and Deputy Manager,
MB, ChB, MRCP Clinical Research Department, Imperial Chemical
Industries PLC, Pharmaceuticals Division,
Alderley Park, Macclesfield, England.
A. J. Taggart Consultant Physician and Senior Lecturer,
MD,MRCP Department of Therapeutics and Pharmacology,
Queens University, Belfast, Northern Ireland.
v. Wright Professor of Rheumatology, Rheumatism
MD, FRCP Research Unit, University department of
Medicine, General Infirmary at Leeds, England.
Preface
This book is about the drugs used in the treatment and management of
rheumatic disorders. The term 'therapeutics' used in the title is intended to
mirror the relevance of drugs in the widest sense of the word. Thus, general
principles underlying pharmaceutical and pharmacological study have been
included together with more clinical matters concerned with applying specific
rheumatic problems.
The need for another work on rheumatological drugs in itself, as opposed to
the different approach intended, was prompted by the ever continuing and
bewildering plethora of antirheumatic drugs flooding the market at present.
We believe that such a burgeoning of new preparations is welcome in an era
when in general there are still no 'cures' available. Moreover, we also feel that
a continued update of this rapidly advancing field is essential, not only for its
own sake, but also to place it in perspective with itself and with neighbouring
fields.
When the volume was first envisaged it was felt that a realistic approach
would be to divide the work into three main sections in order to highlight the
general principles of therapeutics (Section I), the specifics of antirheumatic
pharmacology (Section II), and the clinical application of these two disciplines
(Section III). With this in mind, it was felt appropriate that editors with a
special interest in each of these areas be responsible for sections covering these
different therapeutic aspects. That this might engender some overlap between
sections was considered justifiable if the general aim of providing a global view
on rheumatological therapeutics be achieved.
Another point raised early in the planning stage was the question of includ-
ing brief notes on 'para-therapeutic' details of rheumatic management in order
to provide a perspective backcloth to the general theme of drug therapy. It is
also hoped, therefore, that in providing brief comments on non-drug aspects,
notably on remedial therapy and surgery, the readers will have placed before
them a more general viewpoint on rheumatological therapeutics than might
have resulted from a work totally confined to drugs.
A further aim was to present therapeutic material in a way that reasonably
reflects what clinicians actually do in practice, as opposed to what they preach!
To further this aim, contributors have been encouraged to include practical
advice based on their day-to-day experiences, in addition to the more academic
matters implied by their other term of reference - critical review of the past
and present field.
