To stop the erosion of hope: the DMARD category and the place of semantics in modern rheumatology.

The category of disease-modifying anti-rheumatic drugs (DMARDs) emerged in the 1970s to describe drugs capable of altering the long-term destructive course of arthritis. It became a core concept in rheumatology's reorientation towards pharmaceuticals in the late twentieth century. By examining the earliest use of the term "disease-modifying" in scientific publications, this paper identifies the drugs that the category described when it first emerged. Leaning on systematic reviews of each of these drugs towards the end of their career in rheumatology, it then establishes that posterity would not recognize any of these early DMARDs as capable of altering the long-term course of the disease. The notion of disease-modifying drugs was thus originally used to categorize drugs that were not disease-modifying. Instead of interpreting this inconsistency as an anomaly, the paper argues that the DMARD category may have gained currency because it allowed a number of actors to respond pragmatically to an ongoing crisis in the pharmacological approach to treating arthritis. The term offered to conjure prospects of disease-modifying effects regardless of drugs' actual capacities, and thus to semantically solve the tensions between needs and means that characterized rheumatology at the time. While shedding light on a pivotal moment in the history of rheumatology, the paper also models an approach to understanding drug categories as meaning-making mechanisms by which people can mediate the sometimes uneasy connections that exist between medical practice and science.

A history of the term "DMARD".

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.

Origins and impact of the term 'NSAID'.

This article is an historical investigation of the term non-steroidal anti-inflammatory drugs and its acronym NSAIDs. Drug names and categories tend to be taken at face value in everyday practice, as natural categories existing in their own right. The main argument of this article is that the term NSAID is a reminder that drug names and categories are complex cultural and social products that have been created by specific people, for specific purposes, through specific historical processes, and that this is relevant for their use today. The article locates the first appearances of the phrase non-steroidal at the entry to the 1960s, when the iatrogenic tragedies that followed from the introduction of corticosteroids had become apparent, and where a clear separation between these drugs and emerging anti-inflammatory alternatives was needed. The article then shows how both the phrase and the acronym appeared for the first time out of specific textual contexts in publications by Michael W. Whitehouse, before they were taken up by a wider community and transformed into concepts independent on the context of their first appearances.