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| Autoimmune Diseases: Rheumatoid Arthritis (RA) | | This page was written by Shelley Ensz, and has not yet been medically edited. See Disclaimer. | | | |
| Treatments for Rheumatoid Arthritis |
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| Overview of Rheumatoid Arthritis Treatments |
| Treatments for Rheumatoid Arthritis include medications such as immunosuppressants and biologics, alternative therapies and supplements, and exercise. Many patients respond to a combination of medication and alternative therapies. ISN. |
| Rheumatoid Arthritis Treatments. It is essential that the patient and the patient’s family be educated about the nature and course of the disease. The major goals of treatment of the arthritis are to reduce pain and discomfort, prevent deformities and loss of joint function, and maintain a productive and active life. Johns Hopkins University. |
| Treatments for Rheumatoid Arthritis include nonsteroidal anti-inflammatory drugs (NSAIDs); COX-2 inhibitors; corticosteroids; disease-modifying antirheumatic drugs (DMARDs) such as hydroxychloroquine (Plaquenil), the gold compound auranofin (Ridaura), sulfasalazine (Azulfidine), minocycline (Dynacin, Minocin), methotrexate (Rheumatrex); immunosuppressants; tumor necrosis factor (TNF) blockers; and joint replacements. Immunosuppressants include leflunomide (Arava), azathioprine (Imuran), cyclosporine (Neoral, Sandimmune) and cyclophosphamide (Cytoxan). Mayo Clinic. |
| Sex Differences And Rheumatoid Arthritis. Sex hormone balance is a crucial factor in the regulation of immune and inflammatory responses. Modulation of this balance should represent part of advanced biologic treatments for RA. Medical News Today. 01/03/07. (Also see: Causes of Scleroderma: Hormones and Chromosomes) |
| Clinical Trial: Pain and Stress Management for People With Rheumatoid Arthritis. Self-management of rheumatoid arthritis (RA) symptoms using written emotional disclosure (ED), coping skills training (CST), or a combination of both may benefit people with RA. The purpose of this study is to determine the benefits of these therapies together in adults with RA. This study will be conducted at Wayne State University in Detroit, Michigan and Duke University Medical Center in Durham, North Carolina. NIH. Study dates 2005-2009. |
| Single-Blind Randomized Trial of Combination Antibiotic Therapy in Rheumatoid Arthritis. Combined antibiotic therapy with intravenous clindamycin and oral tetracycline may be useful in the management of active RA. A double-blind, placebo-controlled trial of therapy is justified. J Rheumatol 2006;33:224-7. |
| Sarcoidosis succumbs to antibiotics-implications for autoimmune disease. From time to time there have been reports of autoimmune disease succumbing to tetracycline antibiotics, but many have assumed this was due to coincidence, or to some ill-defined 'anti-inflammatory property' of the tetracyclines. But now the inflammation of sarcoidosis has succumbed to antibiotics in two independent studies. Finally, data showing that the behavior of this hormone is also aberrant in rheumatoid arthritis, systemic lupus erythematosus, and Parkinson's, raise the possibility that these diseases may also have a CWD bacterial pathogenesis. PubMed. Autoimmun Rev. 2004 Jun;3(4):295-300. (Also see: Lupus, Sarcoidosis and Causes of Scleroderma: Infection) |
| Alternative Therapies |
| Alternative treatments for rheumatoid arthritis include relaxation techniques, meditation, hypnosis, acupressure, acupuncture, yoga, and nutritional supplements such as fish oils, bromelain and pancreatin, and vitamins A, C, and E, selenium, and zinc. A diet rich in fish and berries may also be helpful. If your flare-ups of rheumatoid arthritis have been linked to food allergies, work with an allergy specialist to determine which foods you need to avoid. Milton S. Hershey Medical Center, College of Medicine. |
| The use of fish oil in the community: results of a population-based study. Fish oil has been demonstrated to have symptomatic benefits and improve disease activity in Rheumatoid Arthritis. C. Hill. Rheumatology. January 27, 2009. (Also see: Alternative Therapies) |
| Green Tea Protects Rats against Autoimmune Arthritis by Modulating Disease-Related Immune Events. The polyphenolic compounds from green tea (PGT) possess anti-inflammatory properties. Green tea induced changes in arthritis-related immune responses. We suggest further systematic exploration of dietary supplementation with PGT as an adjunct nutritional strategy for the management of Rheumatoid Arthritis. Hong Ro Kim. The Journal of Nutrition. November 2008. |
| Cod liver oil (n-3 fatty acids) as an non-steroidal anti-inflammatory (NSAID) drug sparing agent in rheumatoid arthritis. Out of 49 patients 19 in the cod liver oil group and out of 48 patients 5 in the placebo group were able to reduce their daily NSAID requirement by >30%. (PubMed) Rheumatology (Oxford). 2008 Mar 24. (Also see: Alternative Therapies, and Pain Management) |
| Why Should Rheumatologists Consider Vitamin D Supplementation for their Patients? Given the low cost of vitamin D, its excellent tolerability, combined musculoskeletal- and suggested antiinflammatory/ cardio-vascular benefits, vitamin D supplementation holds a significant public health potential. IngentaConnect. Current Rheumatology Reviews, Vol 3, No 2, May 2007, pp. 129-134(6). (Also see: Causes of Scleroderma: Vitamin D Deficiency) |
| Collateral Benefits of Fish Oil Therapy for Rheumatoid Arthritis. In a small study, the proportion of patients in remission at 3 years was greater in the Fish Oil group than the No Fish Oil group (72% vs 31%). Editorial, Journal of Rheumatology. Vol 33: No 10 Oct 2006. (Also see: Alternative Therapies) |
| Exercise |
| A dynamic exercise programme (DEP) to improve patients’ disability in rheumatoid arthritis (RA): a prospective randomized controlled trial. DEP was effective on functional status assessed by health assessment questionnaire (HAQ), quality of life and aerobic fitness at 1 month. A. Baillet. Rheumatology Advance Access. February 11, 2009. |
| Rheumatoid arthritis (RA), cardiovascular disease and physical exercise: a systematic review. There is strong evidence suggesting that exercise from low to high intensity of various modes is effective in improving disease-related characteristics and functional ability in RA patients. Rheumatology 2008 47(3):239-248. |
| Medications |
| Like many rheumatic diseases, not all rheumatoid arthritis patients respond to the same medication; therefore, patients try several different medications in hopes that one will eventually relieve their symptoms and slow the progression of the disease. ISN. |
| Depression in rheumatoid arthritis (RA) patients treated with anti-TNF is common and under-recognized in the rheumatology clinic. Patients with persistent depression tended to respond less well to anti-TNF, with smaller reductions in DAS28. Given that a significant reduction in DAS28 is a requirement for continuing therapy, recognition and appropriate management of depression may improve TNF effectiveness. Samantha L. Hider, PhD. Rheumatology. July 16, 2009. |
| Tumor necrosis factor blockers may not cause cancer after all. Study finds no increased risk of lymphoma or tumors associated with anti-TNF therapy over methotrexate use among rheumatoid arthritis patients. EurekAlert! 08/31/06. (Also see: Clinical Trials) |
| New cell-based targets for treating autoimmune inflammatory diseases. Studies uncover platelet-regulating gene mutation involved in lupus nephritis and novel adhesion molecule implicated in rheumatoid arthritis. EurekAlert! 08/31/06. (Also see: Lupus) |
| Biologics |
| Treatment impact on estimated medical expenditure and job loss likelihood in rheumatoid arthritis: re-examining quality of life (QoL) outcomes from a randomized placebo-controlled clinical trial with abatacept. QoL findings for abatacept led to greater reduction in medical expenditure and likelihood of an inability to work. The strong effect sizes obtained for all significant analyses suggest that the results are clinically meaningful. J. C. Cole. Rheumatology Advance Access. May 17, 2008. |
| Cost-Effectiveness of Abatacept in Patients with Moderately to Severely Active Rheumatoid Arthritis (RA) and Inadequate Response to Tumor Necrosis Factor-α Antagonists (anti-TNF). Abatacept is cost-effective by current standards of medical practice in patients with moderately to severely active RA and inadequate response to an anti-TNF. Montserrat Vera-Llonch. J Rheumatol July 15 2008. (Also see: TNF Inhibitors) |
| Who Receives Biologics For Treatment Of RA? In multivariable comparisons of biologic users versus a subgroup of patients predominantly managed with steroids, biologic use was associated with younger age, lower baseline pain level, shorter disease duration, and less co-morbidity. Esi Morgan DeWitt. 74/74. ACR 2007. (Also see: Medications) |
| The impact of infliximab treatment on quality of life in patients with inflammatory rheumatic diseases. Patients in large randomized controlled studies of infliximab in Rheumatoid Arthritis, psoriatic arthritis, and ankylosing spondylitis had similar impairment in physical aspects of health-related quality of life (HRQoL) at baseline and showed significantly greater improvement in HRQoL after treatment with infliximab. Arthritis Research & Therapy 2007, 9:R103. (Also see: Psoriasis, and Medications) |
| Latest Data Show MabThera(R) Provides Significant and Sustained Relief From Signs and Symptoms of Rheumatoid Arthritis. New data demonstrate that MabThera's (rituximab) effectiveness in relieving patients of the distressing symptoms of rheumatoid arthritis is sustained or further improved with subsequent courses of treatment, as is the number of patients achieving remission. CNW Telbec. 06/14/07. |
| The efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment: Results of a phase IIB randomized, double-blind, placebo-controlled, dose-ranging trial. Research to examine the efficacy and safety of different rituximab doses plus methotrexate, with or without glucocorticoids, in patients with active rheumatoid arthritis resistant to disease-modifying antirheumatic drugs (DMARDs), including biologic agents. Wiley Interscience. 05/02/06. |
| Efficacy and safety of combination etanercept (ETN) and methotrexate (MTX) versus etanercept alone in patients with rheumatoid arthritis (RA) with an inadequate response to methotrexate: the ADORE study. Both the addition of ETN to MTX and the substitution of ETN for MTX in patients with RA who had an inadequate response to MTX resulted in substantial improvements in clinical signs and symptoms and were generally well-tolerated. PubMed. Ann Rheum Dis. 2006 Nov;65(11):1478-83. |
| Corticosteroids |
| Low-dose Prednisolone in Rheumatoid Arthritis (RA): Adverse Effects (AE) of Various Disease Modifying Antirheumatic Drugs (DMARD). Low-dose glucocorticoids retard radiological progression of RA and exhibit a differential effect on survival of DMARD and degree of AE due to DMARD. J Rheumatol April 15 2008 (Also see: Medications: steroids and DMARDS) |
| Glucocorticoids and cardiovascular events in rheumatoid arthritis: A population-based cohort study. RF-positive but not RF-negative patients were at increased risk of cardiovascular events following exposure to glucocorticoids. (Wiley InterScience) Arthritis and Rheumatism Vol 56, Issue 3, Pages 820 - 830. (Also see: Medications) |
| Corticosteroid Use in Rheumatoid Arthritis (RA): Prevalence, Predictors, Correlates, and Outcomes. Corticosteroid use is associated with adverse longterm outcomes, but the ability to discern causal associations is severely limited by confounding by indication. The idea of "once on corticosteroids, always on corticosteroids" is incorrect and applies to only a minority of patients. J Rheumatol 2007;34:696-705 4 April 2007. (Also see: Medications) |
| Studying the Benefit/Risk Ratio of Glucocorticoids (GC) in Rheumatoid Arthritis GC treatment is a dynamic process, with lots of patients stopping or starting these drugs each year. This shows that physicians constantly scrutinize the need for ongoing treatment, although the study also demonstrated that the indication-setting to start or stop GC was highly variable between individual practices. Editorial Journal of Rheumatology Vol 34: No. 4 April 2007. (Also see: Medications) |
| Prednisone associated with increased risk of Pneumonia. Pneumonia is among the major causes of mortality and morbidity in rheumatoid arthritis. According to a study conducted by the National data bank for Rheumatic diseases prednisone is associated with a 70 percent increased risk of developing pneumonia. arthritis.about.com. 03/16/06. (Also see: Medications) |
| DMARDS |
| Functional Improvement After Patients with Rheumatoid Arthritis (RA) Start a New Disease Modifying Antirheumatic Drug (DMARD) Associated with Frequent Changes in DMARD: The CORRONA Database. Our study demonstrates that in clinical rheumatologic practices, more frequent changes in DMARD are associated with greater improvement in function. Indirectly, these data support the concept that DMARD should be changed if optimal responses are not achieved within a specified time. Veena K. Ranganath. J Rheumatol First Release. Sept 1 2008. (Also see: DMARDs) |
| Changing patterns of medication use in patients with rheumatoid arthritis (RA) in a Medicaid population. The utilization of DMARDs increased in TennCare patients with RA, and by 2004, use of biologics was substantial. C. G. Grijalva. Rheumatology Advance Access. May 22, 2008. |
| Triple therapy in early active rheumatoid arthritis: A randomized, single-blind, controlled trial comparing step-up and parallel treatment strategies. Highly effective control of disease activity can be achieved using conventional DMARDs as part of an intensive disease management strategy. Within this setting, step-up therapy is at least as effective as parallel triple therapy. (Wiley Interscience) Arthritis & Rheumatism, 25 Apr 2008. |
| Immunosuppressants |
| Treatment of Psoriatic Arthritis (PsA) and Rheumatoid Arthritis (RA) with Disease Modifying Drugs: Comparison of Drugs and Adverse Reactions. For both diseases methotrexate (MTX) was the most frequently used disease modifying drug (39% of patients with PsA, 30% with RA), with over 70% of patients in both diseases still taking the drug. Journal of Rheumatology. Vol 35: No. 3 March 2008. (Also see: Psoriatic Arthritis) |
| Anti-rheumatic drug use and risk of serious infections in rheumatoid arthritis. In this large cohort of RA patients, the most heightened risk of serious infections was seen with the use of glucocorticoid agents and immunosuppressive DMARDs. Rheumatology. Volume 46, Number 7 Pp. 1157-1160. (Also see: Medications) |
| A Novel Predictor of Clinical Response to Methotrexate (MTX) in Patients with Rheumatoid Arthritis (RA): A Pilot Study of in Vitro T Cell Cytokine Suppression. An in vitro tumor necrosis factor-a suppression assay may help predict clinical response to MTX in RA. Nigil Haroon. J Rheumatol First Release May 1 2008. (Also see: Immunosuppressants) |
| Patients with Rheumatoid Arthritis Undergoing Surgery: How Should We Deal with Antirheumatic Treatment? Continuation of methotrexate (MTX) appears to be safe in the perioperative period. To avoid the antiplatelet effect during surgery, NSAIDs other than aspirin should be withheld for a duration of 4 to 5 times the drug half-life. (Science Direct) Seminars in Arthritis and Rheumatism Vol 36, Issue 5, April 2007, Pages 278-286. (Also see: Rheumatic Treatments) |
| Rheumatoid arthritis could be prevented if the timing is right: Methotrexate shown to delay and prevent RA progression. Patients diagnosed with undifferentiated rheumatoid arthritis could have their disease outlook changed if treatment is given at the right time. Innovations Report. 06/22/06. (Also see: Medications) |
| The Impact of Immunosuppressive Medications on Cardiovascular Events in Rheumatoid Arthritis Patients. TNF blockers were not associated with either a reduction or an increase in the risk of heart attack or stroke compared with the most commonly used RA treatment, methotrexate. American College of Rheumatology. 11/29/06. (Also see: Cardiac Involvement) |
