A history of the term "DMARD"

Abstract

The article outlines a history of the concept of "disease-modifying antirheumatic drugs" or DMARDs--from the emergence in the 1970s of the idea of drugs with decisive long-term effects on bone erosion in rheumatoid arthritis (RA), through the consolidation and popularisation in the term DMARD in 1980s and 1990s. It then examines the usage of the terms "remission-inducing drugs" (RIDs) and "slow-acting anti-rheumatic drugs" (SAARDs), which for some years offered competition to the term DMARDs, thus underscoring the contingency of the establishment of DMARD as a word. Finally, it juxtaposes the apparently spontaneous emergence of the three terms DMARD, SAARD and RID, and the disappearance of the latter two, with a failed attempt in the early 1990s to replace these terms with the new term "disease-controlling antirheumatic treatment" (DC-ART). The analysis highlights the paradoxical qualities of the DMARD concept as robust albeit tension ridden, while playing down the role of identified individuals and overarching explanations of purpose.

Fig. 1

Earliest appearance of the expression “disease-modifying” in the PubMed database. With permission from Gumpel (1976), Rheumatology, Oxford University Press

Fig. 2

This passage from Paulus’ (1982) article is the earliest use of the initialism DMARD that I documented. Typically for initialisms, the term follows in parenthesis after the full phrase. With permission from Paulus, Annals of the Rheumatic Diseases, BMJ Publishing Group Ltd

Fig. 3

Fries, title page, first title containing acronym DMARD. With permission from Fries (1990), The Journal of Rheumatology

Fig. 4

Earliest use of the term “slow-acting anti-rheumatic drugs” identified in PubMed. With permission from Vischer (1979), Agents Actions Suppl, Springer Science+Business Media

Fig. 5

Title page of one of the three publications, in PubMed that had the initialism SAARD in their title. With permission from Capell and Brzeski (1992), Annals of the Rheumatic Diseases, BMJ Publishing Group Ltd

Fig. 6

Classification of antirheumatic drugs proposed in 1992. With permission from Paulus et al. (1992), Arthritis and Rheumatism, John Wiley and Sons

Fig. 7

Revised proposal for classification of antirheumatic therapies. With permission from Edmonds et al. (1993b), Arthritis and Rheumatism, John Wiley and Sons