Reports From National Arthritis Meeting 2004

Perspectives of Interest on Rheumatoid Arthritis from
2004 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:

Newer Treatments

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. TNF promotes the inflammation and its associated fever and signs (pain, tenderness, and swelling) in several inflammatory conditions, including rheumatoid arthritis. By blocking the action of TNF-alpha, infliximab reduces the signs and symptoms of inflammation and stops the progression of joint damage. Remicade is used to treat rheumatoid arthritis, Crohn's disease, and other serious forms of inflammation such as uveitis, psoriatic arthritis, and ankylosing spondylitis. Remicade is given by intravenous infusion over approximately 2 hours, usually every 4-8 weeks.

Researchers from Canada reported 5 of 156 patients that they treated with Remicade developed a form of systemic lupus, drug-induced lupus.

Dr. Shiel's Perspective: Rheumatologists have known that a small percentage of patients using Remicade treatment will develop autoantibodies (antibodies directed against the body's own tissues). Rarely, patients can develop features of lupus and patients are monitored for signs of this condition while taking Remicade.

French researchers found that Remicade treatment raised the blood levels of beneficial "good" cholesterol.

Dr. Shiel's Perspective: The relationship between blood vessel disease (atherosclerosis) and rheumatoid arthritis was highlighted by a number of papers reported at this meeting. The fact that aggressive treatment of the inflammatory disease, rheumatoid arthritis, can improve the cholesterol profile is very encouraging.

Researchers from Texas reported that Remicade with methotrexate was more beneficial than methotrexate alone in sustaining work employment.

Dr. Shiel's Perspective: We know that employment is directly associated with physical function. So this outcome measure of the effectiveness of Remicade is reassuring.

A multicenter study found that patients treated with Remicade had a diminished rate of bone density loss.

Dr. Shiel's Perspective: Patients with rheumatoid arthritis are at risk for the development of osteoporosis. This is felt to be due factors such as cortisone-related medication use, but also simply due to the effects of chronic inflammation. This is good news, though not surprising.



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