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Rheumatoid arthritis

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of rheumatoid arthritis.

Alternative Names

Arthritis - rheumatoid

Highlights

Drug Approvals

• Celecoxib (Celebrex) was approved in December 2006 for treatment of juvenile rheumatoid arthritis (JRA). It is not recommended for patients with systemic onset JRA, a more serious form of the disease.
• Rituximab (Rituxan) was approved in April 2006 for treatment of adult patients with rheumatoid arthritis who have failed to respond to anti-tumor necrosis factor (anti-TNF) drugs. In December 2006, the FDA warned that rituximab has been associated with cases of progressive multifocal leukoencephalopathy, a rare and deadly brain infection.
• Abatacept (Orencia) was approved in December 2005 for treatment of rheumatoid arthritis in adults with moderate-to-severe RA who have not responded to disease modifying anti-rheumatism drugs (DMARDs) or anti-TNF drugs.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

In December 2006, the FDA proposed adding stronger warnings to the labels of NSAIDs. The new warnings will emphasize these drugs’ risk for stomach bleeding and potentially fatal liver damage. The risks are highest when these drugs are taken in combination with each other or with alcohol. NSAIDs should also never be combined with steroids or blood thinner drugs.

Early Treatment of Rheumatoid Arthritis

Several 2006 studies suggest that aggressive treatment of rheumatoid arthritis in its early stages may help lead to remission. Among these findings:

• A combination of methotrexate (Rheumatrex, Trexall) and adalimumab (Humira) works better in improving symptoms and achieving remission than either drug alone.
• A combination of methotrexate and infliximab (Remicade) works better than single drug therapies.
• Intensive dosing with methotrexate produces a higher remission rate than standard dosing.

Rheumatoid Arthritis and Lymphoma

People with severe arthritis have a much higher risk of developing lymphoma than people with milder forms of the disease, according to a 2006 study. The researchers suggest that the chronic inflammatory process of arthritis plays a major role in heightening lymphoma risk. However, this study, combined with other recent research, indicates that drug treatments for arthritis, including biologic response modifiers, do not increase lymphoma risk.

• Review Date: 1/16/2007
• Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

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