Counseling Points - November 2008 - (Page 12)

swollen and eight tender joints, and radiographic evidence of at least one joint with a definite erosion attributable to RA. At 24 weeks, significantly more patients treated with rituximab achieved an ACR 20 response (51% versus 18%); ACR 50 and ACR 70 responses were also significantly higher in the rituximab group (27% and 12%) compared with placebo (5% and 1%).22 Another recent randomized, double-blind, placebocontrolled clinical trial specifically evaluated HRQOL in RA patients taking rituximab.23 The 367 patients included in the study had previously demonstrated an inadequate response to DMARDs, including biologic agents. Patients received two infusions 2 weeks apart of placebo, rituximab 500 mg, or rituximab 1,000 mg, with or without glucocorticoids, and stable doses of methotrexate. Results of this study demonstrated that both rituximab doses in combination with methotrexate were effective in improving all HRQOL outcomes in patients with active RA. At 24 weeks, both groups reported statistically significantly greater improvements on the Short Form-36 (SF-36) measures. Rituximab patients had a statistically significant improvement in physical function, bodily pain, vitality, social function, and role-physical subscale scores versus placebo.23 Conclusion The goals of managing RA are to control disease activity, alleviate pain, maintain function, and maximize quality of life. Early diagnosis and treatment with DMARD therapy that is appropriate for an individual’s disease duration and activity helps to achieve these goals. Nurses who treat individuals with RA play a pivotal role in supporting patients by providing education on the benefits of early treatment, ways to reduce emotional stress and depression, and strategies to promote quality of life. References 1. Bruce TO. Comorbid depression in rheumatoid arthritis: pathophysiology and clinical implications.Curr Psychiatry Rep. 2008;10:258-264. 2. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis 2002 update. Arthritis Rheum. 2002;46:328-346. 3. Bruce B, Fries JF. The health assessment questionnaire (HAQ). Clin Exper Rheum. 2005;23 (Suppl 39):S14-S18. 4. World Health Organization. World Health Organization Quality of LifeBREF (WHOQL-BREF). Accessed August 17, 2008 at www.who.int/ substance_abuse/research_tools/whoqolbref/en/. 5. McNeil MEA. The First Year: Rheumatoid Arthritis. New York, NY: Marlowe & Company. 2005. 6. O’Dell JR. Treating rheumatoid arthritis early: A window of opportunity? Arthritis Rheum. 2002;46:283-285. 7. Ang DC, Choi H, Kroenke K, et al. Comorbid depression is an independent risk factor for mortality in patients with rheumatoid arthritis. J Rheumatol. 2005;32:1013-1019. 8. Schiepers OJ. Cytokines and major depression. Prog Neuropsychopharmacol Bio Psychiatrtry. 2005;2:201-217. 9. 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. Accessed February 12, 2008 at http://nccam.nih.gov/ health/RA/. 10. The Arthritis Foundation. Events and Programs. Accessed October 7, 2008 at http://www.arthritis.org/programs-events.php. 11. Olsen NJ, Stein CM. New drugs for rheumatoid arthritis. N Engl J Med. 2004;21:2167-2179. 12. Saag KG, Teng GG, Patkar N, et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum. 2008;59:762–784. 13. Quinn MA. The therapeutic approach of early intervention for rheumatoid arthritis: what is the evidence? Rheumatology. 2001;40: 1211-1220. 14. Van Riel LCM, Fransen F. DAS28: a useful instrument to monitor infliximab treatment in patients with rheumatoid arthritis. Arthritis Res Ther. 2005;7:189-190. 15. Van Der Kooij SM, de Vries-Bouwstra J, Goekoop-Ruiterman Y, et al. Limited efficacy of conventional DMARDS after initial methotrexate failure in patients with recent onset rheumatoid arthritis treated according to the disease. Ann Rheum Dis. 2007;66:1356-1362. 16. Solau-Gervais E, Laxenaire N, Cortet B, et al. Lack of efficacy of a third tumour necrosis factor alpha antagonist after failure of a soluble receptor and a monoclonal antibody. Rheumatology (Oxford). 2006;45: 1121-1124. 17. Karlsson JA. Treatment response to a second or third TNF-inhibitor in RA. Rheumatology. 2008;4 :507-513. 18. Hyrich KL, Lunt M, Dixon WG, et al. Effects of switching between antiTNF therapies on HAQ response in patients who do not respond to their first anti-TNF drug. Rheumatology. 2008;47:1000-1005. 19. 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. 20. Kremer JM, Genant HK, Moreland LW, et al. Effects of abatacept in patients with methotrexate-resistant active rheumatoid arthritis. Ann Intern Med. 2006;144:865-876. 21. Cohen S, Emery P, Greenwald M, et al. Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy. Arthritis Rheum. 2006;54:2793-2806. 22. 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. 23. Mease PJ, Revicki DA, Szechinski J, et al. Improved health-related quality of life for patients with active rheumatoid arthritis receiving rituximab: Results of the Dose-Ranging Assessment: International Clinical Evaluation of Rituximab in Rheumatoid Arthritis (DANCER) Trial. J Rheumatol. 2008;35:20-30. COUNSELING POINTS™ 12 http://www.who.int/substance_abuse/research_tools/whoqolbref/en/ http://www.who.int/substance_abuse/research_tools/whoqolbref/en/ http://nccam.nih.gov/health/RA/ http://nccam.nih.gov/health/RA/ http://www.arthritis.org/programs-events.php

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Counseling Points - November 2008

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