NEW TREATMENTS

Rheumatoid arthritis almost always requires drug therapy. Drugs can significantly reduce pain in more than half of patients and offer some relief to the others.

People who have rheumatoid arthritis should seek treatment from a rheumatologist (a medical doctor who specializes in the treatment of disease involving the joints, muscles and associated structures).*

Rheumatologists typically prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprcfen (Advil) and naproxez (Aleve), or the corticosteroid prednisone, to control the pain and inflammation associated with the condition.

A majority of rheumatoid arthritis sufferers also are prescribed a medication known as a disease- modifying anti-rheumatic drug (DMARD), which is designed to reduce pain and inflammation and slow progression of the disease.

• Nonbiological DMARDs are synthetic medications that have been available for many years. These drugs reduce joint damage. Nonbiological DMARDs include…
• Methotrexate (Rheumatrex). It suppresses the immune system and minimizes joint destruction. Most patients who take methotrexate experience reduced pain and joint swelling within weeks. It's among the best drugs for slowing the progression of rheumatoid arthritis.

Potential side effects include nausea, diarrhea and, in rare cases, liver scarring and/or inflammation. For this reason, periodic liver function tests are required.

• Hydroxycbloroquine (Plaquenil). This antimalarial drug suppresses immune attacks on the joints. It's often combined with methotrexate for better results. This drug can cause nausea and decreased appetite and, in rare cases, retinopathy (a disorder of the retina, resulting in vision impairment). If you take this drug, you should have regular eye exams.
• Sulfasalazine (Azulfidine). This medication, often used for mild symptoms or in combination with other drugs for severe symptoms, can cause stomach upset, headache and, in some cases, a decrease in disease-fighting white blood cells.

Important: In addition to liver function tests, people who take nonbiological DMARDs require regular blood tests to monitor changes in blood counts.

• Biological DMARDs resemble substances that are naturally present in the body. Most patients who take these newer, more specifically targeted drugs experience improvements in a short time-and some even report a complete remission. Three biologic agents are currently available that inhibit or block a cell protein known as TNF-alpha, which produces the inflammatory response.
• Etanercept (Enbrel). It is usually injected once or twice weekly.
• Adalimumab (Humira). It is given by injection once every two weeks, although it is sometimes given weekly.
• Infliximab (Remicade). This drug is taken in combination with methotrexate. It is given by intravenous (IV) infusion in a doctor's office, usually once every eight weeks. At times, it can be given as frequently as every four weeks.

These drugs may increase the risk for infection. They also can reactivate tuberculosis (TB) in patients who were previously exposed—even if they never had symptoms. A TB skin test is required prior to starting therapy.

Drawback: These drugs are extremely expensive, costing about $15,000 to $30,000 annually, depending on the dose.

NEW DRUG CHOICES

Several new drugs don't have the long-term data of the DMARDs, but they are afi option for patients who don't respond to DMARDS.

• Abatacept (Orencia). Approved by the FDA in December 2005, abatacept inhibits the activity of Tcells, immune cells that play a central role in joint inflammation. It may increase risk for infection.
• Rituximab (Rituxan). Used for 10 years to treat lymphoma, this drug was recently approved to treat rheumatoid arthritis. It reduces circulatory B-cells, a type of white blood cell that has been shown to play a role in the development of rheumatoid arthritis. Rituximab is given by IV infusion every few months. It may increase infection risk.