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 Diego.
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"The more options, the better, because we want to treat people more aggressively and get the disease under control as quickly as possible," Kavanaugh says.
Medication Options for Rheumatoid Arthritis
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 says.
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 cancer treatment.
"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 damage.
"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 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."