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DMARDs can be used in rheumatoid conditions when treatment with NSAIDs alone does not give adequate benefit, or in patients who are taking excessive doses of corticosteroids. Since DMARDs are toxic and the course of rheumatoid arthritis can be unpredictable, their use may be delayed in order to ascertain that severe symptoms are persisting.
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Most patients experience some relief from pain, stiffness and swelling, but these drugs do not alter the course of the disease, prevent tissue destruction or produce remission.
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The process known as first pass metabolism is drastically reduced with ageing.
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Other areas of care suitable for supplementary prescribing are the treatment of musculoskeletal pain in chronic conditions such as rheumatic diseases or in neuro-rehabilitation, womens health and mental health.
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