BACKGROUND: About 2 million Americans suffer from rheumatoid arthritis or RA for short. RA is a process where the immune system attacks the body's joints. The disease can lead to long-term joint damage, resulting in chronic pain, loss of function and disability. Because it is a chronic disease, RA may never go away. Frequent flares in disease activity can occur. RA is a systemic disease, which means it can affect other organs in the body. Early diagnosis and treatment of RA is critical for patients to live productive lives. Studies show early aggressive treatment of RA can limit joint damage, which in turn, limits loss of movement, decreased ability to work, higher medical costs and potential surgery.

SYMPTOMS: RA can start in any joint, but it most commonly begins in the smaller joints of the fingers, hands and wrists. Joint involvement is usually symmetrical, meaning that if a joint hurts on the left hand, the same joint will hurt on the right hand. Symptoms of rheumatoid arthritis include fatigue, stiffness, weakness, swelling, flu-like symptoms, pain, loss of appetite, depression and weight loss.

STANDARD TREATMENTS: There are many different medications available to treat RA. Some of those include:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – These drugs are used to reduce inflammation and relive pain. These are medications such as aspirin, ibuprofen, indomethacin and COX-2 inhibitors such as valdecoxib and celecoxib.

• Analgesic Drugs – These drugs relieve pain but don’t necessarily have an effect on inflammation. Examples include acetaminophen, propoxyphene and morphine.

• Glucocorticoids or Prednisone – These are prescribed in low maintenance doses to slow joint damage caused by inflammation.

• Disease Modifying Antirheumatic Drugs (DMARDs) – These are used with NSAIDs and/or prednisone to slow joint destruction. Examples include methotrexate, injectable gold and penicillamine.

• Biologic Response Modifiers – These drugs directly modify the immune system by inhibiting proteins called cytokines, which contribute to inflammation. Examples are etanercept, infliximab, adalimumab and anakinra.

• Protein-A Immunoadsorption Therapy – This is not a drug, but a therapy that filters your blood to remove antibodies and immune complexes that promote inflammation.

A NEW APPROACH: While current therapies may work for some patients, they don’t work for all. Also, some of the therapies can lose their effectiveness. Now, researchers from Stanford University Medical Center in Palo Alto, Calif., are studying a new treatment. The treatment is called abatacept and it’s given through an IV infusion. In a clinical study, the treatment was given every two weeks and then once a month for six months. Mark Genovese, M.D., says, “It is what we call a selective co-stimulatory modulator. It is a protein. It’s designed to specifically inhibit one of the signals that’s used to communicate with the immune system … It down-regulates the immune system, so you get less activation of a certain type of T-cell.”

GOOD RESULTS: In a study published in the New England Journal of Medicine, researchers found patients, on average, experienced a 50-percent improvement over six months. Dr. Genovese says, “It is a huge benefit to believe that you can get 50 percent of your patients to have a significant improvement in their disease when, in affect, they had tried and failed existing therapies in the past.” So far, only mild side effects such as the risk of infection have been noted with abatacept. Dr. Genovese says the drug is currently awaiting FDA approval. If it does receive approval, he says it may be on the market in 2006.

FOR MORE INFORMATION, PLEASE CONTACT:
Stanford Medical Referral Center
Stanford University School of Medicine
(800) 756-9000