Nov. 29, 2000 -- Until recently, fairly toxic drugs were the only viable option to relieve the pain from rheumatoid arthritis. But according to two new studies, all of that has changed with the availability of newer drugs that target not only the symptoms of the arthritis, but can protect the joints from further damage.
Rheumatoid arthritis is a common and extremely debilitating chronic autoimmune condition that affects more than two million Americans. The disease is called 'autoimmune' because the body's own immune system attacks the joints, and sometimes other organs, mistaking them as foreign objects. Most sufferers are women in their 30s and 40s who often have young children to care for, and the disease can leave them wheelchair bound.
In the studies, published in the Nov. 30, 2000 issue of The New England Journal of Medicine, two drugs -- Enbrel and Remicade -- were compared to a cancer-fighting drug called methotrexate, which is currently the standard therapy for rheumatoid arthritis.
Both Enbrel and Remicade are members of a new class of drugs. Like methotrexate, they target the part of the immune system that attacks the joints in patients with rheumatoid arthritis. These new drugs, however, target a specific part of the immune system vs. the broader action of methotrexate.
"We're talking about a major advance in the therapy of rheumatoid arthritis," John H. Klippel, MD, tells WebMD. "We're using the science base that has been developed around rheumatoid arthritis to develop drugs that can be used to treat the disease, and we hope this is just the beginning." Klippel is medical director of the Arthritis Foundation based in Atlanta and author of an editorial that accompanied the two studies.
"One of the real goals has been to try to develop therapies that prevent damage to the joint, and we're now seeing therapies that do that. ... So, it is critically important that people with suspected rheumatoid arthritis see physicians who are knowledgeable about [these] new treatment approaches," he adds.
Mary Armitage from Ridgefield, Conn. tells WebMD about how rheumatoid arthritis has affected her life. "It started about nine years ago," she says, "with general, all over achiness, which settled in my ankle. For me, that was bad because my big passion is tap dancing." She tried several drugs only to have the symptoms disappear for a while and then reappear stronger than before. Pain also gradually showed up in her elbows and knees.
In the first study, scientists led by Joan M. Bathon, MD, treated about 630 patients in the early stages of rheumatoid arthritis -- described as having the disease for less than three years -- with either a high dose of Enbrel, a low dose of the drug, or a standard dose of methotrexate for a year. Those taking the high dose of Enbrel improved more rapidly and to a higher degree than those taking methotrexate with respect to symptoms. They also showed improvements in joint damage as seen on X-rays. And, importantly, patients taking any dose of Enbrel experienced fewer side effects and infections than those taking methotrexate.
"This study asked this question: If [Enbrel] is begun early in the disease, could it successfully slow or stop the structural damage to the joints? The answer is 'yes'," Bathon tells WebMD. With Enbrel, patients with rheumatoid arthritis "can now be assured that their treatments aren't just 'covering up the pain' but are actually stopping or slowing the progress of the disease." Bathon is an associate professor of medicine in the division of rheumatology at Johns Hopkins University School of Medicine in Baltimore.
Similarly, a study comparing methotrexate alone to Remicade with methotrexate in a group of over 400 patients showed that, after one year, those taking both drugs together had more improvement of symptoms and a higher quality of life. Again, X-rays revealed that damage to the joints stopped in patients on combination therapy but not necessarily in patients taking methotrexate alone.
David Yocum, MD, who was involved in this study says, "patients are very happy because about one-third of them, even with the first [dose of Remicade], can tell immediately the effect on the joints. They feel the decrease in swelling and pain within minutes to hours after the infusion is done. ... I had one patient who couldn't even squeeze the toothpaste out onto her toothbrush in the morning, ... and now she's out driving her car and out of a wheelchair," he says.
Yocum adds, "The beauty of these [new drugs] is they're as effective the first day as they are the 20th year. ... It's having a real impact across the board." Yocum is a professor of medicine and director of the arthritis center at the University of Arizona in Tucson.
Armitage, who will be 60 in March, has been taking Remicade with methotrexate for about three years. She says that almost all her symptoms disappeared within two to three weeks of taking this combination. Today, she is able to dance, take care of her two-year-old grandchild, and enjoy life without pain.