For people with rheumatoid
arthritis, medications are a fact of life
-- helping control pain and swelling, and preventing damage to joints. The
newest drugs can even stop the disease in its tracks.
That's the good news -- the drugs keep improving, bringing real hope for the
millions with this disease. They are more sophisticated than ever before. And
there are more of them, each working in a slightly different way. So if one
drug doesn't help a patient, there are options, says Arthur Kavanaugh, MD, a
rheumatologist and professor of medicine at the University of California at San
"The more options, the better, because we want to treat people more
aggressively and get the disease under control as quickly as possible,"
Kavanaugh tells WebMD.
The tried-and-true anti-inflammatory medications can relieve pain, improve
daily function, reduce joint swelling and tenderness, and improve range of
motion -- and that's all good. "All my patients take these drugs," Kavanaugh
But there's so much more. In the past two decades, drugs that target the
immune system have become a backbone of treatment. A class of drugs called
disease-modifying antirheumatic drugs (DMARDs) is able to alter the course of
rheumatoid arthritis by suppressing or interfering with the immune activity
that attacks joints.
Some of these medications are traditionally used in treating other diseases
-- like cancer or inflammatory bowel disease, or to prevent rejection of a
transplanted organ - and have been found to also help with rheumatoid arthritis
treatment. However, when a chemotherapy medication like methotrexate (Rheumatrex) is used, the dosage is much
lower -- with considerably less risk of side effects -- than when used in
"We use [DMARDs] aggressively from the start," says Kavanaugh. ""We use them
early on, push harder on the doses, to get things turned around more quickly."
However, DMARDs don't work for all patients, he notes. In those cases, the new
biologic agents have offered new treatment options.
Biologic Drugs: The New Frontier in Treating Rheumatoid Arthritis
Indeed, the newer class of drugs - the biologic agents - shows even greater
promise for more patients, Kavanaugh says. These drugs can prevent or delay
damage to joints, even halt the disease, because they target the malfunctioning
immune system -- a big factor in rheumatoid arthritis, he explains.
Abatacept (Orencia), etanercept (Enbrel), infliximab (Remicade), adalimumab
(Humira), and anakinra (Kineret) are FDA-approved biologic agents for treatment
of rheumatoid arthritis. They interfere with immune system chemicals called
cytokines -- all of which are involved in inflammation-related joint and tissue
"With the advent of these [cytokine] blockers, we can target specific
components of the immune system -- not the entire immune system," he explains.
"Each of these works differently, and they are very good therapies."
In February 2006 the FDA approved
RituxanFDA approved Rituxan -- in combination with
methotrexate -- for the treatment of RA. It's the first RA treatment that
selectively targets immune cells known as CD20-positive B cells. B cells are
believed to play a role in the inflammation associated with RA. Rituxan is
intended for patients who have not improved with treatments called tumor
necrosis factor (TNF) antagonists, such as Enbrel and Remicade.
"These newer treatments are able to work better, and work in a greater
number of patients," Kavanaugh adds. "We're now able to improve signs and
symptoms, make people more functional, keep quality of life up, and do a much
better job of preventing damage. We really are seeing a big difference. Greater
numbers of people are able to stay functional."