31st July 00:07
Rheumatoid Arthritis (methotrexate down tumor rheumatoid arthritis arthritis)
Treatment algorithms for rheumatoid arthritis (RA) have changed
dramatically over just the past ten years. "What has become clear, and
this is quite a difference in our thinking about the disease, is that
the damage may occur very early in the disease process," says Clifton
Bingham, MD. "And the rate of that damage, in a large group of
patients, appears to be most rapid within the first two years of the
first symptoms of disease. The traditional teaching was that RA is
slowly progressive , in many cases going into a 'burned out' phase in
which there was essentially no utility in treating. We now understand
that the damage occurs quite early, and continues over the lifetime of
patients. With newer medications and treatment approaches, we can
still slow down the rate of progression even in patients with 10 and
12 years of disease activity,."
Early recognition remains a challenge, however, and Dr. Bingham
estimates that as many as half of all RA sufferers are either
undiagnosed or misdiagnosed. A positive rheumatoid factor will be
found in less than 40% of patients in the earliest stages of the
disease, and no more than 80% of patients will ever test positive for
the antibody. X-rays can reveal "marginal erosions" – a diagnostic
characteristic that can occur as early as three months after the first
symptoms and in up to 80% of patients within two years of their
disease. In early stage RA however, there will likely be no X-ray
findings other than swelling around the joints.
One newer diagnostic test, now commercially available, is the
anti-CCP (cyclic citrullinated peptide) antibody which may increase
the ability to detect early RA, especially in those patients who are
rheumatoid factor negative. Dr. Bingham notes, however, that the
pathway to therapy will most likely begin with a clinical evaluation
in the primary care setting.
"The most common symptom the primary care physician should be
aware of is morning stiffness in the joints that persists for more
than an hour. In other forms of arthritis, people may feel a little
stiff for five or ten minutes. In RA there is a very characteristic
stiffness that can persist for several hours. Symmetric arthritis that
involves both sides of the body is classic, as is involvement of the
small joints of the hands and feet."
Non-steroidal anti-inflammatory drugs (NSAIDs) and low-dose
corticosteroids are often used as adjunctive therapy to provide
symptomatic relief. They do not, however, do anything to alter the
disease process. The big change in RA treatment, and expected
outcomes, has been wrought by newer agents that work to halt
"Methotrexate, a disease-modifying anti-rheumatic drug (DMARD),
is now the 'gold standard' of therapy against which everything else is
judged," Dr. Bingham explains. We are using much higher doses than we
did as recently as five years ago. We now understand that aggressive,
rapidly dose-escalated methotrexate can give significant responses in
terms of signs and symptoms.
"The other medications that we have in our armamentarium now,
and where the real excitement is, are the new biologic agents. The
most potent of the currently available agents are directed against
tumor necrosis factor (TNF), a particular protein that is very
important in the pathogenesis of RA. They inhibit the cytokine in
slightly different ways, and they all demonstrate a remarkable
efficacy in the treatment of disease.
"Patients are traditionally started on a biologic DMARD if they
have an inadequate response to aggressive dosing of methotrexate. The
biologic DMARD drugs are also effective as monotherapy with the
exception of infliximab, which is given only in conjunction with
methotrexate. There is growing evidence that combination therapy may
be better than monotherapy with either methotrexate or with a biologic
These biologic agents are indeed new. The first, etanercept,
received FDA approval in late 1998 and the newest product in this
class, adalimumab, came to market earlier this year. (Others in the
class include infliximab and anakinra.) Methotrexate and the new
biologic DMARDs not only help with signs and symptoms, they can
significantly slow, and sometimes arrest, the progression of RA. Dr.
Bingham says, simply, "…it's a very, very big deal."
"What we used to accept even five or ten years ago as a good
response in RA is not even close to what we now expect. Our
expectations are tremendously higher in terms of what outcomes we want
to achieve. We used to accept 40% of patients getting 20% better as
being good. Now we see in some clinical trials that 30-40% of patients
are getting 70% better, and we're now getting 70% of patients 20%
better. Not only are people feeling better in terms of their signs and
symptoms, we are improving their function and quality of life. We are
getting people back to work; we are getting people doing what they
want to do with their lives; and on top of it all we are shutting down
the disease process to the point where we're not seeing the X-rays
"Without adequate treatment, up to half of all patients with RA
are completely disabled in ten years. With current treatment paradigms
and the advent of biological DMARDS, functional disability of patients
is much less than previously seen. We are truly altering the outcomes
of this disease."
1st August 09:22
RHEUMATOID ARTHRITIS (rheumatoid arthritis arthritis)
About one in a hundred people get rheumatoid arthritis.
People of any age can develop it, but it’s most common
between the ages of 30 and 50. It affects three times as
many women as men.
Rheumatoid arthritis makes joints become inflamed –
swollen and hot. In most diseases, inflammation helps
healing. But in rheumatoid arthritis it actually causes
The inflammation happens in the thin synovial membrane
that lines the joint capsule, the tendon sheaths (tubes
in which the tendons move) and the bursae (sacs of fluid
that allow the muscles and tendons to move smoothly over
each other). The joints and inflamed tissues then become
stiff, painful and swollen.
Rheumatoid arthritis can be hard to diagnose as it often
develops gradually. But morning stiffness and painful,
swollen joints are important to report to your doctor.
How will it affect me? Rheumatoid arthritis affects
everyone differently, and can be hard to predict when
you’re first diagnosed. It tends to go through active and
inactive phases. During flare ups, when it’s active,
joints become more painful and inflamed. You may also
feel generally unwell and tired.
Most people have some problems with their joints and
flare-ups from time to time, but overall they can carry
on as normal, with adjustments. For some people - around
one in five - rheumatoid arthritis can be relatively
inactive, and there is little or no noticeable damage to
their joints. A few people - around one in 20 - have very
active arthritis for many years, and a series of bad
flare-ups. Several joints can be involved, and rheumatoid
arthritis is likely to have a serious impact on their
However badly and however long you have rheumatoid
arthritis, there are some common difficulties
o pain and loss of strength and movement in inflamed
joints feeling generally unwell and tired
o stiffness can be bad, especially first thing in the
morning, or after sitting still for a long time
o the frustration of not being able to get on with life
without your arthritis interfering
Usually starts in the wrists, hands or feet. If it
continues, it can spread to other joints and affect other
parts of the body.
To find out more about rheumatoid arthritis, order a copy
of our booklet, Rheumatoid Arthritis: a guide.
Or download one here (pdf file, 987k).
Disclaimer: The information on this site is for general use
only and is not intended to provide personal medical advice
or substitute for the advice of your healthcare team. If you
have questions or concerns about your arthritis, please consult
your healthcare team.
Page last updated May 21, 2002
Source - http://www.arthritiscare.org.uk/aboutarthritis/aboutarth_what_rheum.cfm?region=uk
End of forwarded message
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