Counseling Points - October 2007 - (Page 12)

In recent years, there has been an enormous amount of research evaluating therapy with biological responsemodifying DMARDs in RA. Treatment with these newer drugs has a number of potential advantages over conventional DMARDs.1,10,19,24 For example, biologic agents have novel mechanisms of action to target specific molecules that play pivotal roles in the disease process. Some of these drugs attack inflammatory cytokines, such as TNF-α, IL-1, and IL-6, which have been linked to the inflammatory and erosive process of RA. Other agents modulate T cells or target B cells that express a specific protein that is involved in the RA disease process. 1,10,19,24 Moreover, biolog ic DMARDs also have a more rapid onset of action than conventional DMARDs and improved dosing schedules that range from administration every other week to as long as every other month. Although biologics overall induce fewer toxic side effects than conventional DMARDs, they are still associated with adverse events such as infection (sometimes severe), skin irritation, and leukopenia.24,25 Currently approved biological response-modifying drugs for the treatment of RA are abatacept, adalimumab, anakinra, etanercept, infliximab, and rituximab. These agents are approved for use not only in RA, but also in multiple therapeutic areas. Abatacept, infliximab, and rituximab are administered as an intravenous infusion, while adalimumab, anakinra, and etanercept are given as a subcutaneous injection. Their indications vary and some compounds can be used alone, in combination with other DMARDs, or after therapy failure with other drugs. In addition, a number of investigational biologic treatments for RA are currently being evaluated in various stages of clinical trials. disability, and mortality, improving the quality of life for patients with this disabling disease. References 1. Kipple J. Primer on Rheumatic Diseases 12th Edition. New York, NY: Springer; 2001. 2. Davidson A, Diamond B. Autoimmune diseases. N Engl J Med. 2001;345(5):340-350. 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. Lipsky PD. Rheumatoid Arthritis. In: Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005. 5. Albers JM, Kuper HH, Van Riel PL, et al. Socio-economic consequences of rheumatoid arthritis in the first years of the disease. Rheumatology. 1999;38:423-430. 6. Choy EH, Panayi GS. Cytokine pathways and joint inflammation in rheumatoid arthritis. N Engl J Med. 2001;344(12):907-916. 7. Gabriel SE, Crowson CS, Kremers HM, et al. Survival in rheumatoid arthritis. Arthritis Rheum. 2003;48:54-58. 8. Michaud K, Wolfe F. Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2007;21(5):885-906. 9. Aithal GP, Mansfield JC. The risk of lymphoma associated with inflammatory bowel disease and immunosuppressive treatment. Ailment Pharmacol Ther. 2001;15(8):1101-1108. 10. Rindfleisch JA, Muller D. Diagnosis and management of rheumatoid arthritis. Am Fam Physician. 2005;72(6):1037-1047. 11. Maetzel A, Li LC, Pencharz J, et al. The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension. Ann Rheum Dis. 2004;63(4):395-401. 12. Wolfe F, Hawley DJ, Wilson K. The prevalence and meaning of fatigue in rheumatic disease. J Rheum.1996;23(8):1407-1417. 13. Kuder SA, Peshimam AZ, Agraharam S. Environmental risk factors for rheumatoid arthritis. Rev Environ Health. 2002;17:307-315. 14. Yan Z, Lambert N. Prospective study of fetal DNA in serum and disease activity during pregnancy in women with inflammatory arthritis. Arthritis Rheum. 2006;54:2069-2073. 15. Symmons DP, Bankhead CR, Harrison BJ, et al. Blood transfusion, smoking, and obesity as risk factors for the development of rheumatoid arthritis: results from a primary care-based incident case-control study in Norfolk, England. Arthritis Rheum.1997;40:1955-1961. 16. Arend WP. The pathophysiology and treatment of rheumatoid arthritis. Arthritis Rheum.1997;40:595-597. 17. Klareskog L, Padyukov L, Ronnelid J, et al. Genes, environment, and immunity in the development of rheumatoid arthritis. Curr Opin Immunol. 2006;18(6):650-655. 18. Gorman JD, Criswell LA. The shared epitope and severity of rheumatoid arthritis. Rheum Dis Clin North Am. 2002;28:59-78. 19. O’Dell JR. Therapeutic strategies for rheumatoid Arthritis. N Engl J Med. 2004;25:2591-2602. 20. Brooks P, Hochbert M. Outcome measures and classification criteria for the rheumatic diseases. A compilation of data from OMERACT (Outcome Measures for Arthritis Clinical Trials), ILAR (International League of Associations for Rheumatology), regional leagues and other groups. Rheumatology. 2001;40:896-906. 21. Ory PA. Interpreting radiographic data in rheumatoid arthritis. Ann Rheum Dis. 2003;62:597-604. 22. Scott DL, Symmons DPM, Coulton BL, et al. Long-term outcome of treating rheumatoid arthritis: results after 20 years. Lancet.1987;1:1108-1111. 23. Ollier WE, Harrison B, Symmons D. What is the natural history of rheumatoid arthritis? Best Pract Res Clin Rheumatol. 2001;15:27-48. 24. Kippel JH, Dieppe PA, Ferrie F. Primary Care Rheumatology. Barcelona, Spain: Mosby; 2002. 25. Olsen NJ, Stein CM. New drugs for rheumatoid arthritis. N Engl J Med. 2004;21:2167-2179. Summary Although a definitive cause of RA has yet to be identified, it has been documented that early diagnosis and treatment can positively impact the disease course. Initiating treatment with effective drug therapies within the first few months of symptom manifestation can slow or stop disease progression, modify the disease course, prevent damage to joints, and reduce severity, COUNSELING POINTS™ 12

Table of Contents Feed for the Digital Edition of Counseling Points - October 2007

Counseling Points - October 2007 Welcome Introduction Overview of RA RA Morbidity and Mortality RA Costs and Quality of Life RA Risk Factors Pathophysiology of RA Diagnosis and Natural History of RA Diagnostic Tests and Radiography Natural History and Progression of RA Disease Management Treatment Strategies Summary Continuing Education Posttest Evaluation Form

Counseling Points - October 2007

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