2005 ACR/ARHP Annual Scientific Meeting: Reports from National Arthritis Meeting
William Shiel Jr., MD, FACP, FACR, Editor of MedicineNet's Arthritis Overview, Offers Perspectives Of Interest On Topics From 2005 Annual Scientific Meeting of The American College of Rheumatology (held November 12-17, 2005)
Rheumatoid Arthritis Treatment Update
This is Dr. William Shiel, chief medical editor for MedicineNet.com and Rheumatologist reporting from the 2005 annual scientific meeting of the American College of Rheumatology in San Diego - the national arthritis meeting.
I'm delighted to report that there are a huge amount and variety of research papers presented at this meeting on rheumatoid arthritis. Rheumatoid arthritis is the topic of this segment from the meeting
Rheumatoid Factor and Citrulline Antibody
Researchers reported that rheumatoid factor appears very early as does citrulline antibody -- often times in patients who eventually develop rheumatoid arthritis. In fact it seems to be much earlier in patients who develop rheumatoid arthritis after the age of forty years. We know that both rheumatoid factor positively and citrulline antibody -- also known as CCP antibody, is associated with more aggressive disease in rheumatoid arthritis. Researchers also reported that citrulline antibody is associated with the risk of eventual development of rheumatoid arthritis and may present even up to 12 years prior to development of rheumatoid arthritis. Now, it should be noted that this does not mean that because you have citrulline antibody or rheumatoid factor present you will definitely develop rheumatoid arthritis. It just means that doctors will need to be monitoring your situation over time and should symptoms develop that are consistent with rheumatoid disease, treatment may be warranted.
Rheumatoid Arthritis - Treated Seriously and Diligently
Researchers from Japan reported that tight control of rheumatoid arthritis with aggressive treatment is necessary to prevent disability. Simultaneously, researchers from the Netherlands also reported that immediate Disease-Modifying Antirheumatic Drugs treatment (DMARDs) are necessary to prevent eventual surgical treatment. What these two papers mean is that rheumatoid arthritis needs to be treated seriously and diligently and preferably early in order to prevent damaged to cartilage, bone, .deformity, and eventual disability. These two papers significantly support previous studies.
The higher risk of heart disease and stroke was emphasized in a number of patients presented at this meeting. It is noted that because of this higher risk patients should receive appropriate screening for cardiovascular disease such as cholesterol measurement, obesity control, etc.
Researchers from the Netherlands also reported that the injectable drug for arthritis -- Humira also known as adalimumab inhibits x-ray progression in rheumatoid arthritis despite numbers that appear to be in good control that signify inflammation is at a minimum and disease is controlled by other clinical measures. In other words, when the disease is still progressively active by signs of inflammation the x-rays were not becoming worse or indicating more damage to bone and joint. So apparently Humira seems to provide good control and protection for the bone.
Researchers from Stanford, UCSD, Texas, and Britain reported analogously to the previously mentioned study for the same clinical response in a patient with rheumatoid arthritis -- those that were being treated with methotrexate had worse x-ray progression then those who received methotrexate and Humira (adalimumab). This difference in x-rays was noticed at six months and increased during the two years of the study. This study also emphasizes that x-ray progression was better controlled when an aggressive such as the treatment such as the injectable Humira was added the methotrexate treatment. It was also noted by researchers in Sweden, UCSD, University of Texas Southwestern that Humira taken every other week with or without methotrexate is fine as a treatment for the vast majority of patients and that weekly Humira did not significantly add benefit to most patients and that weekly Humira does not significantly add benefit to most patients. You see sometime doctors will advocate or recommend weekly Humira in patients that aren't doing well. This study tells us that we should still start out with every other week regimen.
Tumor Necrosis Factor (TNF) and Methotrexate
A paper was presented that showed that patients that received anti tumor necrosis factor (TNF) treatment with methotrexate did better and had a more sustained response to treatment then those that received TNF alone. It seems that combination therapy is more effective in treating rheumatoid disease. Moreover, researchers from the Netherlands reported that patients who failed methotrexate alone adding another DMARD (disease modifying anti-rheumatic drug) or switching to another DMARD was not significantly effective, but adding Remicade (infliximab) was helpful. This seems to indicate that when we fail an initial DMARD it is very reasonable to step up treatment to the aggressive anti-rheumatic treatment that blocks TNF -- Enbrel (etanercept), Remicade (infliximab), and Humira (adalimumab).
Abatacept - New Treatment for Rheumatoid Arthritis
Finally the last paper I would like to present was a paper from Stanford, University of Cincinnati, Denver, and France in a multicenter study with a new treatment that may be available soon. This treatment whose generic name is abatacept, is used by intravenous infusion. This significant paper demonstrates that abatacept works in patients who fail treatments that are directed against tumor necrosis factor (TNF). This seems to be true in the research for any stage of rheumatoid arthritis. By way of background, not all patients respond to TNF drug treatment (Remicade, Emberal, and Humira). Abatacept which works by a very different mechanism then these TNF drugs may soon be an option for patients whose rheumatoid disease did not respond to TNF inhibiting drug.
For more on rheumatoid arthritis information, go to the Rheumatoid Arthritis Center.
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