Rheumatoid arthritis (RA) is an autoimmune systemic inflammatory disease which affects up to 0.8% of the population which translates into 2.4 million Americans. It’s cause is due to genetic susceptibility and environmental factors which research is beginning to identify. It causes joint pain, stiffness, patterned symmetrical joint swelling of the fingers and wrists (being most common), deformities, X-ray damage, decreased function, poor quality of life and disability. RA contributes to other disease states such as heart attacks and strokes. The diagnosis is made on the symptoms, examination, blood tests known as rheumatoid factor and anti-CCP antibody, X-rays, ultrasound, and MRI.
Cortisone (e.g. prednisone) and NSAIDs e.g. ibuprofen, naproxen can help symptoms but do not have the ability to modify the joint destruction and functional decline. They may cause stomach bleeding, poor kidney function, high blood pressure and cardiovascular side effects among other side effects.
Disease modifying anti-rheumatic drugs (DMARDs) have the capacity to drive the disease to a low activity state. The gold standard methotrexate at 15-25 mg per week, Arava, sulfasalazine, and the less potent Plaquenil are examples. But they often fail to induce remission. Newer biologic agents especially when used with methotrexate can affect good clinical outcomes. They include Enbrel, Remicade, Humira, Orencia, Rituxan, Cimzia, Simponi, and Actemra (listed in the order of approval by the FDA). However, even on these agents most RA patients do not achieve remission and they also may cause mild and serious side effect which limit their use. More research is needed to refine treatments with these agents and to identify new more effective, safe and less expensive drugs to help patients with RA. Only when RA patients volunteer for clinical research trials are better therapies discovered.
The physicians in practice at Arizona Arthritis & Rheumatology Associates and their research division Arizona Arthritis & Rheumatology Research are dedicated to the care of patients with RA. They helped develop the available RA therapies and are investigating new drugs on the horizon. We encourage patients with RA to contact us to participate in our growing research efforts and to become patients of our cutting edge rheumatology center.
By Dr. John Tesser, MD, Rheumatologist