Hitting Rheumatoid Arthritis Hard
Aggressive Treatment More Effective, Reduces Work Disability
Oct. 25, 2002 -- For the best treatment in early stages of rheumatoid arthritis, experts have two suggestions -- act quickly and see a specialist.
Both strategies help ensure that patients are more likely to get the best type and combination of drugs found to be most effective in treating this disabling form of arthritis, according to two studies presented at the annual meeting of the American College of Rheumatology.
In one study, Canadian researchers found that people with rheumatoid arthritis (RA) were more likely to receive disease-modifying antirheumatic drugs (DMARDs) such as methotrexate -- considered the best first-line defense in slowing disease progression -- when treated by a rheumatologist. In tracking more than 29,000 patients over five years, they found that 80% were given DMARD treatment by a rheumatologist, who specializes in arthritis treatment, compared with 53% of patients seeing a general internist and 14% seeing their family physician.
In another study, Finnish researchers found that patients who got prompt treatment with combination DMARD therapy from rheumatologists were more likely to return to work sooner than those receiving just one DMARD. The patients getting combination drug therapy went on work disability one-third less frequently than those receiving a single drug, the researchers found.
"It's pretty exciting because for years, we've known that work loss is the most economically damaging aspect of rheumatoid arthritis," says Edward Yelin, PhD, director of the Arthritis Research Group at the University of California, San Francisco. "On average, the per-person cost of rheumatoid arthritis in the U.S. is about $20,000 per year. Of that, about two-thirds results from lost work wages due to disability."
Yelin tells WebMD that both studies indicate the effectiveness of DMARD medications, but the Finnish report also gives new credibility to a growing trend of prescribing different types of these drugs to treat early symptoms. "DMARDs are very effective, but since these drugs work on different biological mechanisms, it stands to reason that combination therapy might affect more of those mechanisms and have a greater effect," he says.
That study backs previous findings that combination therapy helps slow progression of the joint damage caused by the disease, but was specifically looking at how this regimen affected patients' ability to work. "Most people with advanced rheumatoid arthritis are unable to work at all, so early treatment with combination therapy to slow progression could have a major impact on future earnings," says Yelin, professor of health policy studies who tracks these trends.
The Canadian study is also significant because it reinforces the importance that patients are treated with DMARDs -- which is more likely to occur under the care of a rheumatologist, says lead researcher Diane Lacaille, MD, of the Arthritis Research Centre of Canada at the University of British Columbia.
"Other doctors may not be as familiar with the current guidelines of therapy," says Yelin. "All the drugs used to treat rheumatoid arthritis can have serious side effects -- including DMARDs, which can cause liver problems. But recent advances have been made in their safety. And when you consider that nonsteroidal anti-inflammatory drugs such as Cox-2 inhibitors can cause stomach bleeding and don't provide the same relief, rheumatologists are more likely to recommend DMARDs, which are much more effective and less likely to cause liver damage than NSAIDs are to cause stomach burning." -->