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.
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
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
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
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
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
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
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
Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, March 2000
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