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Logo of procrsmedFormerly medchtJournal of the Royal Society of MedicineProceedings of the Royal Society of Medicine
Proc R Soc Med. 1976 March; 69(3): 163–167.
PMCID: PMC1864162

Samuel Hyde lecture. Polypharmacy in rheumatoid arthritis--help or hindrance?


The use of multiple drugs in treating rheumatoid arthritis is based on the assumption that their effects are additive. Sometimes the results are unexpected or the added drug may confer no additional benefit to the patient whilst leaving him more liable to undesirable side-effects. Some form of polypharmacy may be necessitated by the different pharmacological properties of our drugs. Certain drugs have been judged on their steroid-sparing effects allowing lower doses to be used and thereby reducing the toxicity of corticosteroids. It is likely that some potential areas of danger from interacting drugs have been over-emphasized, being based on speculative rather than real data or purely on animal experiments using non-clinical doses. The patient with active RA with a low serum albumin would be unusually susceptible to changes induced by combinations of strongly bound anti-inflammatory drugs. He would also be highly susceptible to side-effects, as has been shown with prednisone. Side-effects here are doubled when the patients serum albumin is below 2.5g/100ml(lewis et al.1971). I believe we should continue to ask ourselves whether by subtracting one or more drugs from the patients cocktail we may not produce a most welcome benefit for both patient and doctor and, I suppose we could even add, the hard-pressed tax payer.

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Selected References

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  • Barraclough DR, Muirden KD, Laby B. Salicylate therapy and drug interaction in rheumatoid arthritis. Aust N Z J Med. 1975 Dec;5(6):518–523. [PubMed]
  • Birkett DJ, Pond SM. Metabolic drug interactions--a critical review. Med J Aust. 1975 May 31;1(22):687–693. [PubMed]
  • Blackwell B. The drug defaulter. Clin Pharmacol Ther. 1972 Nov-Dec;13(6):841–848. [PubMed]
  • Brodie BB. Displacement of one drug by another from carrier or receptor sites. Proc R Soc Med. 1965 Nov;58(11 Pt 2):946–955. [PMC free article] [PubMed]
  • Champion GD, Paulus HE, Mongan E, Okun R, Pearson CM. The effect of aspirin on serum indomethacin. Clin Pharmacol Ther. 1972 Mar-Apr;13(2):239–244. [PubMed]
  • Garnham JC, Raymond K, Shotton E, Turner P. The effect of buffered aspirin on plasma indomethacin. Eur J Clin Pharmacol. 1975 Feb 28;8(2):107–113. [PubMed]
  • Gugler R, Shoeman DW, Huffman DH, Cohlmia JB, Azarnoff DL. Pharmacokinetics of drugs in patients with the nephrotic syndrome. J Clin Invest. 1975 Jun;55(6):1182–1189. [PMC free article] [PubMed]
  • Jeremy R, Towson J. Interaction between aspirin and indomethacin in the treatment of rheumatoid arthritis. Med J Aust. 1970 Jul 18;2(3):127–129. [PubMed]
  • Klinenberg JR, Miller F. Effect of corticosteroids on blood salicylate concentration. JAMA. 1965 Nov 8;194(6):601–604. [PubMed]
  • Weser JK, Sellers E. Drug interactions with coumarin anticoagulants. 2. N Engl J Med. 1971 Sep 2;285(10):547–558. [PubMed]
  • Levy G, Lampman T, Kamath BL, Garrettson LK. Decreased serum salicylate concentrations in children with rheumatic fever treated with antacid. N Engl J Med. 1975 Aug 14;293(7):323–325. [PubMed]
  • Lewis GP, Jusko WJ, Graves L, Burke CW. Prednisone side-effects and serum-protein levels. A collaborative study. Lancet. 1971 Oct 9;2(7728):778–780. [PubMed]
  • Muirden KD, Deutschman P, Phillips M. Competition between salicylate and other drugs in binding to human serum protein in vitro. Aust N Z J Med. 1974 Apr;4(2):149–153. [PubMed]
  • Mustard JF, Packham MA. Factors influencing platelet function: adhesion, release, and aggregation. Pharmacol Rev. 1970 Jun;22(2):97–187. [PubMed]
  • Nies AS, Oates JA. Clinicopathologic conference: hypertension and the lupus syndrome--revisited. Am J Med. 1971 Dec;51(6):812–814. [PubMed]
  • Swingle KF, Grant TJ, Jaques LW, Kvam DC. Interactions of anti-inflammatory drugs in carrageenan-induced foot edema of the rat. J Pharmacol Exp Ther. 1970 Apr;172(2):423–425. [PubMed]
  • Van Arman CG, Nuss GW, Risley EA. Interactions of aspirin, indomethacin and other drugs in adjuvant-induced arthritis in the rat. J Pharmacol Exp Ther. 1973 Nov;187(2):400–414. [PubMed]

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