Reports From National Arthritis Meeting

Dr. Shiel Gives Perspectives Of Interest On Rheumatoid Arthritis From
2001 Annual Scientific Meeting Of The American College Of Rheumatology

Introduction

Rheumatoid arthritis (RA) is an autoimmune disease that can cause chronic inflammation of the joints and other areas of the body. Rheumatoid arthritis can affect persons of all ages. Its cause is unknown. Rheumatoid arthritis is a chronic disease that is characterized by periods of disease flares and remissions. In RA, multiple joints are usually, but not always, affected in a symmetrical pattern (affecting both sides of the body). The chronic inflammation of RA can cause permanent joint destruction and deformity. The "rheumatoid factor" is an antibody blood test that can be found in 80 percent of patients with RA.

Rheumatoid arthritis is a common rheumatic disease, affecting more than two million people in the United States. The disease is three times more common in women than in men. It afflicts people of all races equally. The disease can begin at any age, but most often starts after age forty and before sixty. In some families, multiple members can be affected, suggesting a genetic basis for the disorder.

There is no known cure for RA. The treatment of RA optimally involves a combination of patient education, rest and exercise, joint protection, medications, and occasionally, surgery. Currently, doctors feel that the earlier patients with RA receive aggressive treatment, the better their long-term outcome.

Below are perspectives on key reports presented at the recent national meeting of the American College of Rheumatology:

New Treatments

Some of the biggest new from this year's meeting related to the newer medications used to treat RA. Here are summaries in this area:

Remicade (infliximab)

Remicade (infliximab) is an antibody that blocks the effects of tumor necrosis factor alpha (TNF-alpha). TNF-alpha is a substance made by cells of the body that has an important role in promoting inflammation. By blocking the action of TNF-alpha, infliximab reduces the signs and symptoms of inflammation.

Remicade was a topic in over 100 papers presented at the meeting, most of which related to RA. Remicade, an approved treatment for RA, is given by intravenous infusion every 2 months.

Researchers at this meeting reported Remicade to be effective and safe in treating RA. Some reported an 80% significant response rate in the first year of use.

Dr. Shiel's Perspective: This is my experience with this medication. Very effective in calming the pain, stiffness, and swelling from the inflammation due to arthritis in a high percentage of patients.

It was also reported by researchers from the Netherlands that a combination of Remicade/methotrexate prevents structural damage to the joints of patients with RA, regardless of whether or not the patient was feeling better!

Dr. Shiel's Perspective: The fact that blocking TNF with drugs like Remicade and Enbrel stops disease progression has already been shown. The interesting point of this study is that they seem to prevent joint damage irrespective of whether patients' signs and symptoms of arthritis were improving. This seems to imply that the drug has an essential effect in stopping the rheumatoid disease.

Remicade or Enbrel treatments resulted in the increased ability of patients to work.

Dr. Shiel's Perspective: While it seems patently logical that controlling a disease that results in loss of function would help people return to the work place, it is good to see it documented.

Remicade was also effective for treating juvenile rheumatoid arthritis, thereby resulting in a significant and prompt reduction in disease activity and improved quality of life. And, another paper presented data demonstrating that doses of Remicade that are higher than currently recommended doses could be effective and necessary in juvenile rheumatoid arthritis.