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What is Rheumatoid Arthritis (RA)?
Rheumatoid arthritis is a form of arthritis that lead to inflammation in the lining of the joints (ortho means joint and it is means inflammation). Rheumatoid arthritis can last for many years and can effect many different joints in the body. Over time, RA can damage various parts of a joint, such as cartilage, bone, tendons and ligaments.
Who Gets RA?
Anyone can be diagnosed with RA, including children and the elderly. However, most people get RA during their young-to-middle adult years. Women are diagnosed with RA approximately three times more often than men are. Over two million people in the United States have RA.
How can I manage my RA?
Your doctor can suggest different ways to help you manage RA, including over-the-counter and prescription medications. Other treatments may include rest, to reduce pain and discomfort, exercise and physical therapy treatment.
Specific exercises will assist you in maintaining muscle strength and joint mobility. Exercise under the guidance of a physician is particularly important. Exercise improves your strength, endurance and flexibility, so that you can perform daily activities better. The key is to maintain a proper balance between rest and physical activity. Many people with RA can safely participate in appropriate regular exercise programs. Low-impact movement – such as swimming or bicycling – is especially beneficial, because it provides great cardiovascular exercise, without tiring or harming your body’s joints. Always check with your physician before beginning or changing an exercise routine.
In addition to recommending exercise, rheumatologists may refer you to physical or occupational therapies. Physical therapy can help you maintain range of motion in your joints, whereas occupational therapy can teach you ways to cope with the day-to-day problems associated with the disease.
Medication Choices:
There are several different types of medications to help relieve you RA signs and symptoms. Your rheumatologist will determine which medications to prescribe based on the severity of your disease. A number of factors can determine whether a particular drug will work for you, including how much pain and stiffness you feel, how advanced your disease is and how you respond to various medications. It is sometimes necessary to be on several medications at once, or to switch treatments from time to time. The following is a list of the most commonly prescribed medications for RA:
Non-steroidal Anti-inflammatory Drugs (NSAIDs):
NSAIDs are prescribed to quickly reduce the pain associated with RA. They also reduce joint inflammation, although this benefit can be delayed for four to six weeks. NSAIDs can make you feel better temporarily, but they do not alter the course of RA or prevent joint destruction. They have side-effects such as stomach upset, stomach ulceration and bleeding.
Some of the most commonly prescribed NSAIDs including Relafen (nabumetone), Naprosyn (naproxen), Arthrotec (diclofenac sodium and misoprostol), Daypro (oxaprozin) and Motrin (ibuprofen).
A new category of NSAIDs is called COX-2 inhibitors. Drugs in this class have fewer gastrointestinal side-effects because they do not interfere with an enzyme that is beneficial to the stomach lining. They have the same effect as NSAIDs. Like other NSAIDs, COX-2 inhibitors do not alter the progression of the disease. Medications in this category include Celebrex (celecoxib) and Vioxx (rofecoxib).
Corticosteroids:
Corticosteroids are steroids that have Anti-inflammatory effects. They are prescribed to quickly relieve RA signs and symptoms such as pain and inflammation. However, physicians may have to monitor you more closely when you are on corticosteroids because of the possible development of serious side-effects, including weight gain, osteoporosis, glaucoma, hypertension and cataracts. The side-effects of these drugs can increase both with longer usage and higher doses.
Commonly prescribed corticosteroids include prednisone and Medrol (methylprednisolone).
Disease-Modifying Antirheumatic Drugs (DMARDs):
Medications in this class are prescribed to patients who continue to experience joint pain, significant morning stiffness, fatigue or other symptoms, even though they have taken high doses of NSAIDs. These drugs can slow the loss of cartilage and bone adjacent to the joint. However, benefits are often delayed for weeks or months.
Some DMARDs may have side-effects that will increase with the duration of treatment, so these drugs may require patients to be monitored with laboratory tests for side-effects.
Commonly used medications in this group include gold compounds, sulfasalazine, Rheumatrex (methotrexate), Plaquenil (hydroxychloroquine sulfate), Solganal (aurothioglucose) and Arava (leflunomide).
Methotrexate is one of the most commonly prescribed DMARDs. It appears to act more rapidly than other DMARDs, and provides longer effective relief from symptoms. Rheumatologists may have to increase the dosage of the drug during the course of your treatment to maintain its effectiveness. Despite increasing doses, the effectiveness of methotrexate can still taper off in some patients. Methotrexate is well-tolerated by most patients. It should not be used if you are pregnant, breast-feeding or planning to become pregnant.
Biological Response Modifiers:
This new class of biologic agents has been shown to have substantial benefits in patients for whom other therapies are inadequate. They target the body's immune system to control the process of inflammation, significantly reducing disease activity.
The most common side-effects of biological response modifiers are injection-site reactions and infections. The medications should be used with caution if you are at risk for infections. Drugs in this class include Remicade, Enbrel and Humira and Abatacept:
Remicade (infliximab) - an intravenous (IV) infusion therapy used with methotrexate. Healthcare professionals administer Remicadeto patients once every eight weeks after a starting dose regimen (please see full prescribing information at www.remicade.com)
Remicade is part of a class of advanced biologic agents that has been shown to have substantial benefits in patients with a number of inflammatory disorders involving the immune system. These biologic agents target specific proteins in the body's immune system to control the development of inflammation, significantly reducing painful symptoms in diseases such as ulcerative colitis, Crohn's disease, ankylosing spondylitis, psoriatic arthritis, and rheumatoid arthritis.
Remicade is given by IV infusion, a simple process that usually takes about two hours. A healthcare professional administers the treatment in a supervised environment, which is either a physician's office or a treatment center. You will receive your first dose followed by additional doses at two and six weeks after the first dose. You will then receive a dose every eight weeks. If you have AS, you will receive treatment every six weeks.
With Remicade , all you have to do is come for your appointment. Your healthcare professional will carefully calculate the dosage customized to your weight so that you get the best response to the treatment. Individual results may vary.
Enbrel (etanercept) - a subcutaneous (under the skin) injection that patients give to themselves twice a week.
Enbrel is a type of protein called a tumor necrosis factor (TNF) blocker that blocks the action of a substance your body's immune system makes called TNF. People with an immune disease, such as rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, and psoriasis, have too much TNF in their bodies. ENBREL can reduce the amount of TNF in the body to normal levels, helping to treat your disease. But, in doing so, ENBREL can also lower the ability of your immune system to fight infections.
Enbrel is indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis.
ENBREL can be initiated in combination with methotrexate (MTX) or used alone.
Humira
What is Adalimumab?
Adalimumab reduces the effects of a substance in the body called tumor necrosis factor alpha (TNF-alpha). TNF-alpha is involved in inflammatory processes in the body. Adalimumab is used in the treatment of rheumatoid arthritis. However, it may also be used for purposes other than those listed here. Adalimumab is administered as a subcutaneous (under the skin) injection. Do not inject this medication intramuscularly (into a muscle) or intravenously (into a vein).
Abatacept is an investigational biologic drug for the treatment of rheumatoid arthritis and its development program was granted Fast Track status by the FDA. Abatacept is Bristol-Myers Squibb's first internally discovered biologic and, if approved, would be the first in a new class of agents called selective T-cell co-stimulation modulators.
Talk To Your Rheumatologist
Rheumatologists have experience in a wide range of therapies for RA. If you are diagnosed with RA, your rheumatologist can work with you to determine the best drug or combination of drugs for you. Rheumatologists are highly-trained specialists who want to support you and your management of RA, so be sure to talk to them whenever you have a question or a concern about your medication.
New investigation of therapies will change practice patterns in the near future.
Do I have Arthritis?
What Is Arthritis?
Many people start to feel pain and stiffness in their bodies over time. Sometimes their hands or knees or hips get sore and are hard to move. These people may have arthritis (ar-THRY-tis).
Arthritis is an illness that can cause pain and swelling in your joints. Over time, the joint can become severely damaged. Joints are places where two bones meet, such as your elbow or knee. Some kinds of arthritis can cause problems in other organs, such as your eyes, or in your chest. It can affect your skin, too.
These problems may be caused by inflammation (in-flah-MAY-shun), a swelling that can include pain or redness. They are telling you that something is wrong.
Some people may worry that arthritis means they won't be able to work or take care of their children and their family. Others think that you just have to accept things like arthritis.
It's true that arthritis can be painful. But there are things you can do to feel better. This booklet tells you some facts about arthritis and gives you some ideas about what to do, so you can keep doing the things you want to do.
There are several kinds of arthritis. The two most common ones are rheumatoid (ROO-mah-toyd) arthritis and osteoarthritis (AH-stee-oh-ar-THRY-tis).
Osteoarthritis is the most common form of arthritis. This is the form that usually comes with age and most often affects the fingers, knees, and hips. Sometimes osteoarthritis follows an injury to a joint. For example, a young person might hurt his knee badly playing soccer. Then, years after the knee has apparently healed, he might get arthritis in his knee joint.
