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 drugsʼ 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.