Showing posts with label DMARDs. Show all posts
Showing posts with label DMARDs. Show all posts

Tuesday, December 3, 2013

Imroved RA Treatments Have Led to 50% Reduced Disability and Emotional Distress

Nowadays, only 1 out of 4 RA patients are disabled after the first four years of treatment and the percentages of patients with depressed mood and anxiety have been reduced about 50%, according to a new study published today in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR). That’s good news for patients diagnosed today whose treatment choices, both pharmacological and non-pharmacological, have improved since 20 years ago.

Not only have attitudes toward evidence-based medicine changed in recent decades, but treatment options have increased dramatically.  Rheumatologists are also more likely to recommend non-pharmacological treatments such as physical exercise to patients.
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Physical Disability and Psychological Distress in RA Patients Reduced by 50% in Last 20 Years

Thursday, July 4, 2013

RA Treatment: Triple Therapy

Rheumatologists will often begin their newly diagnosed patients on conventional DMARDs such as methotrexate (MTX), sulfasalazine (SSZ), hydroxychloroquine (HCQ), each alone or in any combination.  In fact, when combining the three drugs, it is commonly known as “triple therapy” and is often used as a step-up in treatment after trying MTX alone.

Triple therapy as a treatment approach to RA has received recent attention in the news due to a study published in the New England Journal of Medicine (NEJM) on June 11, 2013.  In this study, no significant difference in disease activity was demonstrated in patients who received triple therapy as compared to those who received treatment with etanercept + methotrexate. All the patients prior to enrolling in this study had experienced active disease despite methotrexate therapy alone (O’Dell, 2013).

In a similar study, the Treatment of Early Aggressive Rheumatoid Arthritis (TEAR) study, patients were randomly assigned to MTX monotherapy (alone), triple therapy, or MTX + etanercept with no significant difference in primary outcome (based on Disease Activity Severity DAS28 scores) between the latter two groups. However, x-rays did show more disease progression in the triple therapy group.

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What is the Role of Triple Therapy in RA?

Thursday, June 6, 2013

PML Risk and Rheumatic Diseases

Progressive Multifocal Leukoencephalopathy (PML) is a rare, opportunistic infection of the central nervous system (CNS) caused by a reactivation of the JC (John Cunningham) virus.  PML is a brain disorder that affects the white matter part of the brain, specifically targeting the cells that make myelin (oligodendrocytes).  A majority of adults have been exposed to the JC Virus at some point in their lives.  However, PML is a very rare disease which typically does not affect healthy individuals.   

Individuals with autoimmune diseases such as MS, RA, lupus, and vasculitis are at increased risk of PML, primarily due to some of the drug therapies used to treat these autoimmune diseases which alter the immune system and may allow a reactivation of the JC virus.  However, cases of PML in patients using select disease-modifying drugs is still very rare.  Even more rarely, PML has occurred in RA patients who haven’t taken any disease-modifying drugs or biologics.

Read these posts in their entirety:
Progressive Multifocal Leukoencephalopathy: What is PML? Part One

PML Diagnosed in Autoimmune Rheumatic Diseases, Part Two

Thursday, December 27, 2012

Needle-Free Injections: Reality In the Future?

Biologic drugs have been used to treat RA during the past ten years. and are typically used as second-line drugs for patients who do not respond to traditional DMARDs.  Some biologics are used as first-line drugs for select patients with moderately to severely active RA.  There are nine biologics which are used for the treatment of RA, with the first receiving FDA approval in 2001.  A tenth biologic drug, Xeljanz (tofacitinib), was approved in November 2012 and should hit the market soon.

Traditionally, RA patients may be prescribed treatment with one or more of the non-biologic DMARDs before receiving treatment with a biologic drug (which is considered more aggressive).  A recent meta-analysis of 70 studies involving drugs used for RA compared the effectiveness of various treatments and combination of treatments in preventing joint erosion caused by RA as seen on x-ray image.  One outcome of the analysis revealed that combination treatment with 2 DMARDs plus periodic steroid treatment may be as effective as a biologic agent plus methotrexate (Graudal, 2010).

Besides being very expensive, a drawback to the biologic medications has been that they are given as subcutaneous injection (shot under the skin) or intravenous (IV) infusion.  However, many patients who fear self-injections are able to learn to give themselves shots with appropriate training and support.

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DMARDs, Biologics for RA, and Needle-Free Injections