New Arthritis Drugs for 
Rheumatoid Arthritis and Osteoarthritis

Arthritis treatments aim to relieve pain, reduce inflammation, and slow or stop joint damage to maintain or restore the patient's functional ability and quality of life. Arthritis therapies generally used today address the medical needs of many patients. However, these therapies are occasionally associated with harmful side effects ranging from mild to severe. Medical research continues to search for effective, fast-acting treatments with fewer side effects.

New arthritis drugs designed to meet these treatment needs are presently available or awaiting approval by the U.S. Food and Drug Administration (FDA). The foundation for these new drugs was laid in basic biomedical research supported by the National Institutes of Health.

Biological Response Modifiers for Rheumatoid Arthritis

Description: One class of drugs in this category reduces inflammation in the joints by blocking the action of a substance called tumor necrosis factor (TNF). TNF is a protein of the body's immune system that triggers inflammation during normal immune responses; however, when overproduced, TNF can lead to excessive inflammation such as that experienced by patients with rheumatoid arthritis.

Enbrel® (etanercept)

How taken: twice-weekly subcutaneous (under the skin) injections by the patient or health care provider

Most common side effects: mild to moderate injection-site reactions (itching, pain, swelling)

Drug status: approved by the FDA; not recommended for patients with active infections; caution should be used in patients with a history of infections or those who develop new infections while taking Enbrel®; not recommended for pregnant women.

For more information:
Immunex Corporation
51 University Street
Seattle, WA 98101
(800) 436–2735
www.enbrelinfo.com

Remicade® (infliximab)

How taken: intravenous (in the vein) injections by the health care provider once every 8 weeks

Most common side effects: mild infusion reactions

Drug status: approved by the FDA for use in combination with methotrexate; not recommended for pregnant women

For more information:
Centocor
200 Great Valley Parkway
Malvern, PA 19355
(800) 457–6399
www.centocor.com

Disease-Modifying Antirheumatic Drugs (DMARDs) for Rheumatoid Arthritis

Description: These are the mainstay arthritis drugs that are known to relieve painful, swollen joints and to slow joint damage.

Arava® (leflunomide)

How taken: orally, once daily

Most common side effects: diarrhea, hair loss, rash

Drug status: approved by the FDA; not recommended for pregnant women

For more information:
Aventis
P.O. Box 9627
Kansas City, MO 64134–0627
(816) 966–4000
www.aventis.com

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Specifically Cyclo-Oxygenase-2 (COX-2) Inhibitors, for Rheumatoid Arthritis and Osteoarthritis

Description: COX-2 inhibitors, like traditional NSAIDs, block COX-2, an enzyme in the body known to stimulate an inflammatory response. Unlike traditional NSAIDs, however, they do not block the action of COX-1, an enzyme known to protect the stomach lining. Therefore, drugs in this category reduce joint pain and inflammation with reduced risk of gastrointestinal ulceration and bleeding.

Celebrex® (celecoxib) for rheumatoid arthritis and osteoarthritis

How taken: orally once or twice daily, dosage determined by the physician

Most common side effects: abdominal pain, nausea, indigestion, diarrhea

Drug status: approved by the FDA

For more information:
G.D. Searle & Company
5200 Old Orchard Road
Skokie, IL 60077
www.searle.com

Vioxx® (rofecoxib) for rheumatoid arthritis and osteoarthritis, as well as acute pain associated with primary dysmenorrhea (painful menstruation) and postsurgical pain

How taken: orally, once daily

Most common side effects: abdominal pain, diarrhea, indigestion, insomnia, edema

Drug status: approved by the FDA

For more information:
Merck & Co., Inc.
One Merck Drive
Whitehouse Station, NJ 08889–0100
World Wide Web Address: http://www.merck.com/product/usa/

Other Products

Hyalgan® (hyaluronan)

Description: Hyaluronic acid viscosupplementation products for osteoarthritis. These products mimic a naturally occurring substance in the body called hyaluronic acid by providing lubrication to the knee joint, thus permitting flexible joint movement without pain.

How taken: a series of five injections per knee by a health care provider over 4 weeks

Most common side effects: some pain and swelling at the injection site

Drug status: approved by the FDA

For more information:
Sanofi~Synthelabo, Inc.
90 Park Avenue
New York, NY 10016
(800) 446–6267
www.hyalgan.com

Synvisc® (hylan G-F20)

How taken: a series of three injections per knee by a health care provider over a 15-day period

Most common side effects: some pain and swelling at the injection site

Drug status: approved by the FDA

For more information:
Biomatrix, Inc.
65 Railroad Avenue
Ridgefield, NJ 07657
(800) 666–7248
www.biomatrix.com

Prosorba Column® (apheresis)

Description: Blood filtering device for severe rheumatoid arthritis. This device is designed to remove harmful antibodies from the patient's immune system, thus lowering disease activity associated with severe rheumatoid arthritis.

How used: The device consists of a catheter, tubing, and a column. The catheter and tubing are used to filter the patient's blood through the column (which is coated with protein A, a substance that attracts harmful antibodies), then reinfuse it into the patient's body. The procedure takes 2 hours and is performed weekly at a health care facility for 12 weeks.

Most common side effects: flu-like symptoms (chills, fever, nausea, and joint/muscle pain)

Drug status: approved by the FDA

For more information:
Cypress Bioscience
4350 Executive Drive, Suite 325
San Diego, CA 92121
(800) 635–4673
www.cypressbio.com

Additional Resources

To find out more about these drugs and devices, including dosage, full range of side effects, and study results, check the following resources:

• National Library of Medicine's (NLM's) Internet Grateful Med is a computer system that allows users to search through 15 of the NLM's databases for bibliographic references and abstracts on medical and scientific information pertaining to rheumatic diseases, including treatments.
  www.nlm.nih.gov
  
  

• U.S. Food and Drug Administration (FDA), Center for Evaluation and Research, provides information on drugs that have been approved, as well as those undergoing the approval process.
  www.fda.gov/cder
  
  

• The Arthritis Foundation offers The Drug Guide, a reprint from Arthritis Today. 
  www.arthritis.org
  
  

• Local public university libraries have journals on rheumatic diseases and pharmaceutical (drug) therapies, as well as reference books such as the Physician's Desk Reference, an annually updated guide that describes the use, effects, dosages, and administration of FDA-approved drugs, as well as warnings, side effects, and precautions. Many libraries also provide computers with public access to the Internet

Source:  National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892, March 2000