WORDING this topic, the Editor has invited a nice distinction. There I is no definitive therapy for rheumatoid arthritis, if indeed this polymorph disease proved to be a single entity. But we are usually agreed on what constitutes a rheumatoid patient, and we firmly think that we can help most of them though we cannot promise or prove it. Within these limits, what are the goals we may reasonably pursue in their management? AIMS One predictable result over the long stretch is a fair capacity for useful work and social function. Hence our first and abiding concern should be the maintenance of the patient's socio-economic integrity by the prevention of crippling deformities and the adjustment of occupational problems. As a corollary, the correction of existing handicaps is a goal of high order because the majority of all disabled patients, even of those in Class IV, can be advanced by one or more functional classes. Next in feasibility is the arrest or moderation of rheumatoid disease in specific joints or other organs. Anatomically limited lesions do cause general disability and are usually amenable to protective, suppressive or corrective therapy. Yes, we should manage the total patient but we should not overlook the potential of topical treatment to some joints or areas whose involvement impairs general function more than do ordinary degrees of systemic virulence.
The most desirable aim, but the least certain, is the defervescence of rheumatoid arthritis as a general disease of connective tissue. Evidently, rheumatoid arthritis may become arrested or inactive. Of a group of patients in all stages who have currently active disease and whose arthritis has a mean duration of 5 years, between one-fifth and one-third will experience a remission. Although this experience stems entirely from patients receiving various types of treatment, there is no proof that it is due to treatment. Presumably, the natural course of early, subdiagnostic rheumatoid disease has an even higher rate of remission, unrelated to medical management. But the lack of an agent which will reliably cause rhemuatoid disease to abate and the lack of proof for any medical management to modify its long-term course do not invalidate therapeutic attempts at control by safe means.
BASIC MODALITIES
Rest, The prescription of balanced rest has general empirical endorsement. Reduction of physical stresses on a given joint or area by curtailment of daily activities such as walking, standing, stair-climbing, bending, reaching, gripping, carrying or weight-bearing, and the protective uses of canes, crutches, braces, splints or casts usually reduce local inflammation within 83