Aspirin and the treatment of rheumatoid arthritis.

The recent development of other nonsteroidal anti-inflammatory agents (NSAIDs) has challenged the role of aspirin in the initial treatment of rheumatoid arthritis. The ready availability of aspirin as "an over-the-counter" preparation has contributed to its low esteem among both patients and physicians as a truly potent anti-inflammatory agent. But whether these newer, more expensive NSAIDs are more efficacious in the treatment of rheumatoid arthritis than aspirin remains to be proven. Most clinical trials of the newer agents have compared their efficacy against fixed doses of aspirin which were almost always too small to produce optimal anti-inflammatory serum salicylate levels. In our experience, individually tailored doses of aspirin remains the most predictable and consistently effective NSAID available for the initial treatment of rheumatoid arthritis. We also want to make it clear that we almost never rely on aspirin or other NSAIDs to control seropositive rheumatoid arthritis. Their chief advantage is rapidity of action. We do rely on the use of remittive agents to control rheumatoid joint inflammation, in conjunction with aspirin or other NSAID.