| The options available for treatment have expanded | | | | necrosis factor- the major culprit in RA - and by |
| greatly in the last 10 years. | | | | doing so keep it from doing damage. These drugs |
| Non steroidal anti inflammatory drugs: These help to | | | | have a slightly different mechanism of action from |
| reduce pain and improve function. They do not have | | | | each other but they essentially all do the same thing. |
| an effect on the underlying disease. Examples include | | | | And they do it well. These drugs have revolutionized |
| ibuprofen, naproxyn, sulindac, etodolac, nabumatone, | | | | our approach to RA. |
| celecoxib, and meloxicam. | | | | Rheumatologists are using this group of drugs earlier |
| These drugs are effective but they have potential | | | | in the course of disease to hopefully prevent damage |
| side effects including peptic ulcer disease, kidney and | | | | from occurring. There is also some evidence that |
| liver damage, rashes, and fluid retention. Another | | | | early aggressive treatment may prevent some of |
| problem associated with these drugs is the slight | | | | the long term complications of rheumatoid arthritis |
| increase in cardiovascular events such as heart attack | | | | such as lymphoma and cardiovascular events. |
| and stroke. These drugs require careful monitoring. | | | | Potential side-effects of anti-TNF therapy include an |
| Corticosteroids: These drugs suppress inflammation | | | | increased susceptibility to infection, the reactivation |
| but also have no effect on the underlying disease. | | | | of latent tuberculosis, and the development of |
| Examples include prednisone, methylprednisolone, and | | | | lupus-like or MS-like syndromes. |
| prednisolone. Used long term they may have | | | | Kineret, unfortunately, does not have the same |
| undesirable side effects including ulcers, cataracts, | | | | salutary effect and is not used very often. |
| osteoporosis, adrenal gland suppression, thinning of | | | | The second wave of biologic therapies are available |
| the skin, and diabetes. | | | | and offers hope for patients who fail anti-TNF |
| Disease-modifying anti-rheumatic drugs (DMARDS): | | | | treatment. The two newest drugs are abatacept |
| These drugs slow down the progression of | | | | (Orencia) and rituximab (Rituxan). |
| rheumatoid arthritis. Examples would be medicines | | | | Abatacept is a co-stimulatory blocker. This means it |
| such as methotrexate, sulfasalazine (Azulfidine), | | | | prevents T cells from being activated to produce |
| leflunomide (Arava), hydroxychloroquine (Plaquenil), | | | | cytokines. Rituximab is a B-cell depleter. It removes B |
| and cyclosporine (Sandimmune). | | | | cells from a patient's system. B-cells are felt to play a |
| Most DMARDS act slowly. | | | | big role in the development of RA by some experts. |
| The workhorse of DMARDS is probably | | | | Both drugs are given by intravenous infusion. Side |
| methotrexate. All DMARDS have the potential for | | | | effects include infusion reactions and rashes. The |
| significant side-effects and must be monitored slowly. | | | | long-term consequence of B-cell depletion is still |
| Biologics: Most recently, biologic therapies such as | | | | uncertain. |
| etanercept (Enbrel), adalimumab (Humira), infliximab | | | | More biologic therapies are on the horizon. These |
| (Remicade), and anakinra (Kineret) have helped | | | | new drugs may prove to be more effective and |
| tremendously. | | | | safer than what is currently available. |
| These drugs target the cells and cytokines that are | | | | In patients with more severe disease, a procedure |
| the primary cause of rheumatoid arthritis. These | | | | where blood is passed through a special filter |
| drugs work quickly. Etanercept, adalimumab, and | | | | (Prosorba column) may be of use. As one might |
| infliximab are anti-TNF drugs. They block tumor | | | | guess, it is not used very often. |