Arthritis Drugs and New Meds: 2004 Perspectives (cont.)

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.

Remicade was effective in treating sarcoidosis of the lungs and Behcet's disease.

Dr. Shiel's Perspective: Other reports of Remicade treatment of sarcoidosis and Behcet's disease are supported by this report. Remicade seems to have beneficial effects in many diseases that feature microscopic areas of tissue inflammation called granulomas. These diseases include Crohn's disease, Wegener's granulomatosis, and sarcoidosis.

Remicade was also reported to increase work productivity and decrease time lost from work in patients with psoriatic arthritis.

Dr. Shiel's Perspective: Part of overall health is function. This and other studies are reassuring in that the ultimate goals are being met for patients with serious forms of arthritis with aggressive treatments.

Enbrel and Remicade were reported effective in treating ankylosing spondylitis as manifest by improvements in spinal MRI testing.

Dr. Shiel's Perspective: Enbrel has been approved for ankylosing spondylitis treatment within the past year. Remicade will be soon.

Enbrel (etanercept)

Enbrel is an injectable blocker of tumor necrosis factor for treating rheumatoid arthritis and psoriatic arthritis. Tumor necrosis factor (TNF) is a protein that the body produces during the inflammatory response, which is the body's reaction to injury. TNF promotes the inflammation and its associated fever and signs (pain, tenderness, and swelling) in several inflammatory conditions, including rheumatoid arthritis. Enbrel is a synthetic (man-made) protein that binds to TNF. Enbrel thereby acts like a sponge to remove most of the TNF molecules from the joints and blood. This prevents TNF from promoting inflammation and the fever, pain, tenderness, and swelling of joints in patients with rheumatoid arthritis (and apparently other forms of inflammatory arthritis, such as psoriatic arthritis, ankylosing spondylitis, and juvenile arthritis-see below). Enbrel is given by subcutaneous injection with a needle and syringe twice weekly.