Treatment Update on Rheumatoid Arthritis
The following perspectives on Rheumatoid Arthritis, written by William C. Shiel, Jr., MD, FACP, FACR, are the result of information provided at the 2002 Annual Scientific Meeting Of The American College Of Rheumatology
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:
A big splash at the annual National Arthritis Meeting October 24-29, 2002 was made by a new treatment for rheumatoid arthritis. This drug, adalimumab (just approved by the FDA first week of January, 2003 manufactured by Abbott Labs) is a synthetically produced human antibody that binds to a protein that promotes inflammation, TNF-alpha.
In rheumatoid arthritis, excessive TNF-alpha is produced in the joints, playing a pivotal role in stimulating the joint inflammation. Early research has suggested that blocking TNF-alpha can be an effective means of halting the progression of the rheumatoid disease. In fact, TNF blockade is the principle behind two effective drugs now on the market, etanercept (Enbrel) and infliximab (Remicade).
Research presented at the meetings demonstrated the effectiveness and safety of adalimumab, also known as D2E7 (and now Humira), both as a single treatment (monotherapy) and in combination with other disease modifying anti-rheumatic drugs (DMARDs)
Dr. Shiel's Perspective: Indeed, this drug will be a welcome addition for the treatment of rheumatoid arthritis. These studies did document halting of the destructive process to the cartilage and the joints.
Adalimumab (Humira) decreased joint pain while improving general function.
Dr. Shiel's Perspective: The improved quality of life is a key factor in determining an effective treatment for patients with rheumatoid arthritis.
Adalimumab (Humira) was shown at the meetings to be effective in weekly doses of 20mg or every other week doses of 40mg. It is given subcutaneously (generally patients will self-inject).
Dr. Shiel's Perspective: Well, this is good news. Obviously it would be more convenient to administer the medication less frequently.
Research reported a 20% (one in five) rate of injection site reactions from the injections of adalimumab (Humira).
Dr. Shiel's Perspective:It is nice to have these rates. It should be noted that this reactions were mild skin irritation around the injection site. They usually resolved after several injections. Also, Humira will carry a warning on the package insert that accompanies all TNF-blocking agents, which includes notification of possible risk of infections and nervous system disease. These infections are extremely rare in my experience and the drugs must be used with caution, if at all, in persons who have infections.
I believe this medication will be a significant help to doctors and patients in their mutual battle against the immune disease, rheumatoid arthritis.
Medical Author: William C. Shiel, Jr., MD, FACP, FACR
Last Editorial Review: 7/6/2004