Combination Treatment in Autoimmune Diseases. Questo articolo non è disponibile.Combination Treatment in Autoimmune Diseases

W. B. Harrison, B. A. C. Dijkmans During the last decade intervention has been instituted for all kinds of disease- even in a premorbid state, as early as possible, to control the activity of the disease, to avoid further damage and to maintain quality of life. Apart from the principle 'Treat now, not later", emphasis is laid on aggressive initial therapy. These adagia have influenced in recent times all fields of medicine, from oncology to infectious diseases and also - the topic of the present edition - the "autoimmune diseases". As an example of the latter, rheumatoid arthritis (RA) demonstrates how the attitude of physicians has been changed. From an expectant point of view in the eighties (primum nil nocere) the attitude has been changed, as we approached and entered the new millennium, to initial ag­ gressive therapy especially in patients with a poor prognosis. Despite the advance of instituting monotherapy with a single optimised disease-modifying anti-rheumatic drug (DMARD) - with methotrexate as prototype agent in RA - adequate disease re­ mission is not often achieved, and adverse events may well prevent the use of higher dosages of the single agent in question. Therefore, the next step was to combine two or more DMARDs. The choice of combining DMARDs can be purely practical and based upon the anti-rheumatics most used in daily practice, for instance methotrexate and sulphasalazine. The choice of combining drugs can be influenced by different toxicity patterns to avoid cumulative toxicity.

This book consists of contributions from the most prominent experts in this field. In the first section the general principles of combination treatment are discussed, from rationale and methodology to benefits of risks in daily practice. The second section concerns specific diseases. It is striking that although there is so much experience with combining DMARDS in RA, for several other autoimmune diseases combination therapy has not yet been developed. Denton and Black, on the other hand, are able to add a refreshing new meaning to the term "combination therapy" in systemic sclerosis by pointing out the aetiologies beyond those caused by immunopathology, and dealing with combinations of therapy to address issues beyond immunotherapy.The last section is devoted to the future and the editors hope to come back in 2010 with an issue which will look back and determine whether the predictions of Brooks, Moore, Huizinga and Breedveld have come true.