Rheumatoid Arthritis - 2001 National Meeting (cont.)

Adalimumab

This is a new drug that is not commercially available. Adalimumab (D2E7) is the first fully human, monoclonal antibody in development. Adalimumab is an investigational agent designed to block the activity of tumor necrosis factor alpha (TNF-a), which contributes to the inflammation in autoimmune diseases such as RA. This drug, which is given by subcutaneous injection every 2 weeks, was effective in combination with methotrexate and seems to be well tolerated other than occasional injection site reactions. It is not yet commercially available, but is worth keeping an eye on.

Dr. Shiel's Perspective: Well, here comes a new kid on the block. It will be important to watch for further research on this drug. It may well be an effective addition to our current treatments. Injecting only every 2 weeks would be relatively convenient.

Valdecoxib

Valdecoxib is a nonsteroidal anti-inflammatory drug (NSAID) that is being studied for use in the treatment of RA. It is not yet commercially available. Prostaglandins are chemicals that are important contributors to the inflammation of arthritis, which causes the pain, fever, swelling, and tenderness. Valdecoxib blocks the enzyme that makes prostaglandins (specifically, cyclooxygenase 2 or Cox-2), resulting in lower concentrations of prostaglandins. As a consequence, inflammation and its accompanying pain, fever, swelling, and tenderness are reduced. Cox-2 Inhibitors differ from traditional NSAIDs in that they cause less inflammation and ulceration of the stomach and intestine and do not interfere with the clotting of blood.

Valdecoxib was superior to the placebo and similar to naproxen (at 500mg twice daily) in effectiveness. At the lower doses, it showed less stomach irritation than Naprosyn.

Dr. Shiel's Perspective: This would be a welcome addition to Celebrex, which is the Cox-2 NSAID currently available for the treatment of RA.

Etoricoxib

Etoricoxib is another Cox-2 NSAID that is being investigated for the treatment of RA (see Valdecoxib above). Previous studies have demonstrated its effectiveness in relieving the signs and symptoms of joint inflammation.

Fewer patients treated with etoricoxib had to discontinue the medication because of gastrointestinal complications as compared with the traditional NSAIDs, Voltaren, and Naprosyn.

Dr. Shiel's Perspective: This is an example of a safety study that must be performed before a drug is approved to demonstrate its value. Because it is billed as a Cox-2 inhibitor, etoricoxib should and apparently does, have advantages with regard to the stomach and intestines.

Associated Conditions

Early treatment of RA was clearly reported to have the best outcome.

Dr. Shiel's Perspective: This has long been believed to be true and arthritis specialists (rheumatologists) are treating RA more aggressively and earlier now than in past decades.

Sjogren's Syndrome

An increased bladder irritability was reported in patients with Sjogren's syndrome.

Dr. Shiel's Perspective: This seems to be an under-recognized complication of Sjogren's syndrome. Doctors will have to be vigilant in monitoring this symptom. Patients with symptoms of an overactive bladder should always report them to their doctor.

Smoking and Diet Risks

Heavy smoking was statistically shown to significantly increase the risk of developing RA.

Dr. Shiel's Perspective: As if we needed another reason NOT to smoke!

Researchers from the Universities of Alabama, Iowa, and San Francisco found that decaffeinated coffee intake was associated with an increased risk for the development of RA. Women drinking more than three cups of decaf coffee were at more than twice the risk of developing RA. Women drinking regular coffee were at no increased risk, while women drinking tea were had a 60% decreased risk!

Dr. Shiel's Perspective: This study requires further follow-up studies to confirm these preliminary results, as suggested by the authors of the study.

Patient Education

Education of patients with RA about their disease significantly improved their overall function, according to a paper reported from Canada.

Dr. Shiel's Perspective: Well, this is how I am devoting a major part of my life now here with MedicineNet.com. The reason is because I clearly see the benefits of education in my patients. (I wonder how much, in part, this has to do with being compliant about taking the medications regularly for the RA!)

Education of patients in Korea with RA about their disease significantly improved their fatigue and reduced pain, while improving self-care activities.

Dr. Shiel's Perspective: This was an 8 week intensive course with patients in small groups who were interacting to understand their disease. It would probably apply to anyone with RA who was interested in independently educating him or herself, say via the Internet!

The perceived quality of life of patients with RA improved significantly as a result of an after-day hospital education program.

Dr. Shiel's Perspective: Again, education proves to be a key to providing a higher quality of life for patients with RA.



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