Counseling Points - March 2008 - (Page 12)

should be avoided because studies have indicated an increased incidence of infection when these agents are given concomitantly. Additionally, severe cases of neutropenia and thrombocytopenia have been identified in a small number of patients treated with this medication.40 Future Treatments There are many effective treatments available to help alleviate symptoms and slow or halt the damaging effects of RA, but, as yet, there is no cure for the disease. However, research is advancing rapidly and a number of new drugs are in various stages of investigation. Some of these compounds include inhibitors of specific cytokines, such as TNF, IL-6, and IL-15. 28,41 For instance, tocilizumab (Actemra ® ) is a humanized anti-human IL-6 receptor monoclonal antibody with a unique mechanism of action that slows progression of joint damage. Other drugs being studied target B cells, inhibit proteins such as sykkinase, Janus kinase-3 (JAK 3), or modulate the receptor activator of nuclear factor-kB (RANK) ligand pathway.28,41 Furthermore, medications such as antibiotics, statins, and bisphosphonates already approved for other inflammatory conditions are being studied to determine their effectiveness in RA.41 It is hoped that through the introduction of effective new therapeutic strategies, patients will have increased options to help achieve control over this debilitating disease. References 1. Lichtenstein L, Busse W. Current Therapy in Allergy, Immunology, and Rheumatology, Sixth Edition. Philadelphia, Pa: Elsevier Inc; 2004. 2. O’Dell JR. Therapeutic strategies for rheumatoid Arthritis. N Engl J Med. 2004;25:2591-2602. 3. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis 2002 update. Arthritis Rheum. 2002;46:328-346. 4. Mannheimer C, Lund S, Carlsson CA. The effect of transcutaneous electrical nerve stimulation (TNS) on joint pain in patients with rheumatoid arthritis. Scand J Rheumatol. 1978;7:13-16. 5. Evcik D, Kizilay B, Gokcen E. The effects of balneotherapy on fibromyalgia patients. Rheumatol Int. 2002;22:56-59. 6. Brosseau L, Robinson V, Wells G, et al. Low level laser therapy (Classes I, II, and III) for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2005;Oct 19;(4); CD002049. 7. Thyberg I, Hass UAM, Nordenskiold U, et al. Survey of the use and effect of assistive devices in patients with early rheumatoid arthritis: A two-year follow-up of women and men. Arthritis Rheum. 2004; 51: 413-421. 8. Research Report, National Center for Complementary and Alternative Medicine, Rheumatoid Arthritis and Complementary and Alternative Medicine National Institute of Health US Dept of Health and Human Services. Available at: http://nccam.nih.gov/health/RA/. Accessed February 12, 2008. 9. Kavuncu V. Physiotherapy in rheumatoid arthritis. Medscape General Medicine. 2004;6(2):3-15. 10. Kipple J. Primer on Rheumatic Diseases 12th Edition. New York, NY: Springer; 2001. 11. Ullrich PF. NSAIDs: Non-steroidal Anti-inflammatory Drugs. Spinehealth.com. 2005. Available at: http://www.spine-health.com/Treatment/Medications/Medications-Overview/NSAIDs-Non-Steroidal-AntiInflammatory-Drugs.html. Accessed February 8, 2008. 12. Andermann AAJ. Physicians, Fads, and Pharmaceuticals: A History of Aspirin. 1996. Available at: www.medicine.mcgill.ca/mjm/v02n02/ aspirin.html. Accessed Jan 23, 2008. 13. Gotlieb D. COX 1 and 2: The Cyclo-oxygenase Systems. 2005. Available at: www.arthritis.co.za/cox.html. Accessed Jan 23, 2008. 14. Markenson J. Clinical implications of cyclooxygenase enzymes: COX1/COX-2 role of the new NSAIDs. Cancer Control J. 1999; 6(2S). 15. Konstam MA, Weir MR, Reicin A, et al. Cardiovascular thrombotic events in controlled, clinical trials of rofecoxib. Circulation. 2001; 104(19):2280-2288. 16. Kearney PM, Baigent C, Godwin J, et al. Do selective cyclo-oxygenase2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006; 332(7553):1302-1308. 17. Frohman IP. The steroids. Am J Nurs. 1959;59(4):518-521. 18. Kippel JH, Dieppe PA, Ferrie F. Primary Care Rheumatology. Barcelona, Spain: Mosby; 2002. 19. Rindfleisch JA, Muller D. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2005;72(6):1037-1047. 20. Weinblatt ME, Weissman BN, Holdsworth DE, et al. Long-term prospective study of methotrexate in the treatment of rheumatoid arthritis: 84-month update. Arthritis Rheum. 1992;35:129-137. 21. Chan ESL, Cronstein BN. Molecular action of methotrexate in inflammatory disease. Arthritis Res. 2002;4:266-273. 22. Trexall® (methotrexate) prescribing information. DuraMed Pharmaceuticals, Inc. Pomona, NY. 2005. 23. Fox RI. Mechanism of action of hydroxychloroquine as an antirheumatic drug. Semin Arthritis Rheum. 1993;23(Suppl 1):82-91. 24. Easterbrook M. An opthalmological view on the efficacy and safety of chloroquine versus hydroxychloroquine. J Rheumatol. 1999;26: 1866-88. 25. Azulfidine® (sulfasalazine) prescribing information. Pfizer; New York, NY. 2006. 26. Orsri M, Shea B, Robinson V, et al. Leflunomide for treating rheumatoid arthritis. Cochrane Database Syst Rev. 2003;(1):CD002047. 27. Baumgartner R, Walloschek M, Kralik M, et al. Dual binding mode of a novel series of DHODH inhibitors. J Med. Chem. 2006; 49(4):12391247. 28. Olsen NJ, Stein CM. New drugs for rheumatoid arthritis. N Engl J Med. 2004;21:2167-2179. 29. John Hopkins Arthritis Center. Rheumatoid Arthritis Treatments. Available at: www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/ tnf.html. Accessed February 12, 2008. 30. Rau R. Adalimumab (a fully human anti-tumour necrosis factor monoclonal antibody) in the treatment of active rheumatoid arthritis: The initial results of five trials. Ann Rheum Dis. 2002;61:ii70-ii73. 31. Enbrel® (etanercept) prescribing information. Amgen/Wyeth Pharmaceuticals: Thousand Oaks, Ca. 2006 32. Remicade® (infliximab) prescribing information. Centocor Inc.: Malvern, Pa. 2003. 33. Genovese MC, Becker JC, Schiff M, et al. Abatacept for rheumatoid arthritis tumor necrosis factor alpha inhibition. N Engl J Med. 2005; 353:1114-1123. 34. Chang J, Kavanaugh A. Novel therapies for rheumatoid arthritis. Pathophysiology. 2007;12(3): 217-225. 35. Orencia® (abatacept) prescribing information. Bristol-Myers Squibb Co.: Princeton, NJ. 2005. 36. Cohen S, Emery P, Greenwald M, et al. Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy. Arthritis Rheum. 2006;54(9):2793-2806. 37. Emery P, Fleischmann R, Filipowicz-Sosnowska A, et al. The efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment. Arthritis Rheum. 2006;54:1390-1400. 38. Rituxan® (rituximab) prescribing information. Biogen Idec, Inc and Genentech, Inc; San Francisco, Ca. 2006. 39. Keystone E, Emery P, Peterfy CG, et al. Prevention of joint structural damage at 1 year with rituximab in rheumatoid arthritis patients with an inadequate response to one or more TNF inhibitors (REFLEX) study. Ann Rheum Dis. 2006;65(Suppl II):183. 40. Kineret® (anakinra) prescribing information. Amgen; Thousand Oaks, Ca. 2006. 41. MayoClinic.com. Rheumatoid arthritis drugs in development. Available at: www.mayoclinic.com/health/rheumatoid-arthritis-drugs/ AR00041. Accessed February 20, 2008. COUNSELING POINTS™ 12 http://www.medicine.mcgill.ca/mjm/v02n02/aspirin.html http://www.medicine.mcgill.ca/mjm/v02n02/aspirin.html http://www.arthritis.co.za/cox.html http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/tnf.html http://www.hopkins-arthritis.org/arthritis-info/rheumatoid-arthritis/tnf.html http://nccam.nih.gov/health/RA/ http://www.spine-health.com http://www.spine-health.com http://www.MayoClinic.com http://www.spine-health.com/Treatment/Medications/Medications-Overview/NSAIDs-Non-Steroidal-Anti-Inflammatory-drugs.html http://www.MayoClinic.com/health/rheumatoid-arthritis-drugs/AR00041 http://www.spine-health.com/Treatment/Medications/Medications-Overview/NSAIDs-Non-Steroidal-Anti-Inflammatory-drugs.html http://www.MayoClinic.com/health/rheumatoid-arthritis-drugs/AR00041 http://www.spine-health.com/Treatment/Medications/Medications-Overview/NSAIDs-Non-Steroidal-Anti-Inflammatory-drugs.html

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Counseling Points - March 2008 Welcome Pharmacological and Nonpharmacological Treatment of Rheumatoid Arthritis

Counseling Points - March 2008

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