Fast Diagnosis and Treatment Key to Managing Rheumatoid Arthritis
WebMD News Archive
Jan. 13, 2000 (Los Angeles) -- Early diagnosis and prompt, appropriate
treatment of rheumatoid arthritis (RA) are the keys to minimizing joint and
tissue damage and enhancing quality of life, according to rheumatologist Eric
L. Matteson, MD. Matteson reviewed the latest RA treatment strategies in the
journal Mayo Clinic Proceedings.
RA is one of the most common causes of disability, writes Matteson, an
associate professor of rheumatology and internal medicine at the Mayo Clinic.
"After 12 years of disease, more than 80% of patients with RA are partially
disabled, and 16% are completely disabled. Life expectancy is shortened by an
average of 7 years in men and 3 years in women." Matteson tells WebMD that
the most common causes of decreased life expectancy associated with RA are
vasculitis, or inflammation of the blood vessels; side effects of drugs, such
as bleeding from a stomach ulcer; and an increased risk of infection, which may
be due to the drugs suppressing the immune system. On a more optimistic note,
he says that doctors now have in their armamentarium new drugs tailored to
inhibit specific aspects of RA and these drugs will have a profound effect on
the management of this disease.
The goals of therapy are to relieve pain, control inflammation, prevent
joint destruction, and maintain normal function as long as possible, he writes.
The mainstay of RA therapy should be compounds known as disease-modifying
antirheumatic drugs (DMARDs), such as gold, methotrexate, or tumor necrosis
factor (TNF) antagonists. Enbrel (etanercept), a TNF antagonist, is genetically
engineered to decrease inflammation, which is a vital part of what causes the
pain and destruction associated with RA. These drugs can reduce disability and
death associated with RA and should be introduced as soon as RA has been
"Use of DMARDs has substantially improved disease control and the
long-term outlook for patients with RA," Matteson writes. Many
rheumatologists have come to view methotrexate as the "anchor therapy"
for RA, thanks to its good efficacy and relatively mild side effects. In an
interview seeking objective comment, John Klippel, MD, medical director of the
Arthritis Foundation, tells WebMD that the use of methotrexate and TNF
antagonists are the two most significant advances in RA therapy in the past
Steroids are potent suppressors of inflammation and can be used to control
severe or widespread disease until the DMARDs take effect, which may take
several weeks to months. However, steroids cause serious side effects, such as
infection and increased blood sugar. Matteson recommends that they not be used
alone in RA therapy and should be tapered and ultimately discontinued as soon
as other agents start to work. DMARDs also can be tapered in a patient who has
no active signs of disease for at least a year.