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Treatment Options for Rheumatoid Arthritis

Posted Aug 24 2008 1:49pm
ANNOUNCER: Rheumatoid arthritis can be a painful and debilitating disease. Although there is no cure, there are effective treatment options.

ERIC RUDERMAN, MD: There are really two treatment goals. We're trying to treat the symptoms now, so we're trying to reduce the pain, reduce the inflammation, reduce the impact of those things on a patient's ability to function right now. And at the same time, we're trying to reduce the damage that may occur later, because ultimately that damage may impact function, even if there is no inflammation. And so right from the beginning, we really look to both aims.

ANNOUNCER: A variety of therapies are available to patients. There are agents to treat symptoms and drugs that can affect the long-term course of the disease. Optimal treatment often requires a combination of therapies.

ERIC RUDERMAN, MD: There are nonsteroidal anti-inflammatory drugs, and that includes naproxen or ibuprofen or even some of the newer COX-2 inhibitors, like celecoxib or Celebrex. They treat the inflammation. They may reduce symptoms. But they have no impact whatsoever on the damage that occurs with the disease or the progression of disease. They can be useful drugs, although they have side effects. They can cause a lot of gastrointestinal problems; particularly they're associated with a risk of ulcer or bleeding if not used carefully.

ANNOUNCER: Corticosteriods are another option available to patients.

ERIC RUDERMAN, MD: Steroids are really very potent anti-inflammatories. You can use steroids either orally, as prednisone tablets. You can get an injection, either an intramuscular injection or even an injection into a swollen joint. And they will rapidly improve pain and swelling and stiffness and the symptoms of arthritis.

ANNOUNCER: Corticosteriods should not be used for long periods of time. They can increase a patient's risk for osteoporosis, cataracts, infection and hypertension.

CLIFTON O. BINGHAM, MD: NSAIDs and prednisone and steroids are adjunctive therapy. They're things that we use in addition, they're things that we use as a bridge until these more effective therapies kick in and start to work. We have a class of agents, though, that are called DMARDs or disease-modifying anti-rheumatic drugs. And these are drugs that have actually shown us that they can affect the long-term course of disease in preventing damage and preventing destruction.

ANNOUNCER: Prescribed DMARDs may include hydroxychloroquine, sulfasalazine, leflunomide, or the immunosuppressive agent methotrexate.

ERIC RUDERMAN, MD: The most common disease-modifying drug we use these days is methotrexate. It's effective. It tends to work very well in combination with other medicines if we need to add other things, and most patients tolerate it and do very well on it. It is a drug, however, that does have side effects. It can cause liver damage in a small percentage of people. It can cause effects on blood counts. There are some lung issues with effects on breathing and cough that come up. And so when people are on methotrexate, we do need to monitor them very closely.

ANNOUNCER: A new, highly effective class of DMARDs referred to as biologic response modifiers have been developed to treat rheumatoid arthritis.

ALISA KOCH, MD: We're currently in the age of biologic therapies, or targeted therapies, as they're often referred to. And these therapies were developed specifically to target pathways we think are important in how rheumatoid arthritis develops. Specific pathways that help perpetuate the disease.

CLIFTON O. BINGHAM, MD: The biological DMARDs that came first to rheumatoid arthritis were TNF antagonists. The three that are currently approved are a medication called etanercept or Enbrel, a medication called adalimumab or Humira and a medication called infliximab or Remicade. All of these are very effective in inhibiting the activity of tumor necrosis factor. They each do it in slightly different ways, but they're directed against specifically the tumor necrosis factor molecule and they're either given by injection or by infusion.

ANNOUNCER: Potential side effects of these TNF blockers can range from less severe, like reactions at the site of injection and infusion reactions, to infections including reactivating latent tuberculosis. Other serious concerns include a potential increase in malignancies and lymphoma.

STEVEN ABRAMSON, MD: I think it's an important point that most people with rheumatoid arthritis are not on a single drug. They're on three, four, sometimes five medicines. In fact, the recent evidence, certainly with the TNF blockers, is that the combination of methotrexate plus a TNF blocker is better than either alone.

ANNOUNCER: Early diagnosis and treatment of rheumatoid arthritis is important in order to prevent joint damage and deformities.

ERIC RUDERMAN, MD: I think the odds of completely treating this disease have really improved in the last few years. With the number of treatments that we have available, when I see a new patient with rheumatoid arthritis right now, I can confidently tell them that there's a better than even chance that I can get them to a place where they have no active disease, where it's not impacting their life at all.

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