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Inhibitors Effective for Treatment of Rheumatoid
members of a new class of drugs have been found to reduce the
joint damage associated with rheumatoid arthritis. Rheumatoid
arthritis (RA) is an inflammatory disease that causes pain, swelling,
stiffness, and progressive loss of function in the joints.
Two studies published in the New England Journal of Medicine evaluated
the effectiveness of TNF inhibitors, drugs that neutralize
the inflammatory protein known as tumor necrosis factor (TNF).
TNF is overproduced in the joints of patients with rheumatoid
arthritis and is believed to be responsible for much of the
joint damage in RA.
In one study, conducted at the Johns Hopkins University, in
Baltimore, etanercept (Enbrel) was compared to methotrexate
in 632 patients with early stage rheumatoid arthritis. Etanercept
acted more rapidly to decrease symptoms than methotrexate.
In addition, etanercept was more effective at slowing the progress
of joint erosion; the rate of joint damage, as measured by
x-rays, was significantly reduced in the etanercept group compared
to the methotrexate group. After one year of treatment, 72
percent of the etanercept patients had no progression in joint
erosion compared to 60 percent of the methotrexate-treated
The second study, conducted at the University of Texas Southwestern
Medical Center in Dallas, followed 428 patients with chronic,
active rheumatoid arthritis for 12 months. The researchers
found that a combination of the TNF inhibitor infliximab (Remicade)
and methotrexate significantly reduced the symptoms of RA and
halted progression of joint damage compared to treatment with
methotrexate alone. Nearly 52 percent of the patients taking
the infliximab and methotrexate combination showed symptom
reductions, compared with 17 percent of methotrexate-only patients.
x-ray examination showed that joint damage came to a halt in
patients given the drug combination. In addition, joint damage decreased in
40-55 percent of patients on the combination therapy, implying
that some damage had been repaired. Meanwhile, joint damage
progressed in the group given only methotrexate. The combination
therapy, which was well tolerated, also significantly improved
quality of life.
Methotrexate, the standard rheumatoid arthritis medication,
was approved more than a decade ago for treating certain types
of arthritis and skin conditions. However, it can cause serious
side effects including liver damage. In contrast, both TNF
inhibitors were well tolerated.
An estimated one percent of the adult U.S. population has rheumatoid
arthritis, and it is about two to three times more common in
women than men.
Medication Approved to Treat Eczema
Atopic dermatitis is a chronic, hereditary skin condition that
causes redness, itching, and oozing lesions. It mainly affects
children but can persist into adulthood. Doctors often prescribe
oral or topical corticosteroids for serious cases. But while steroids
are very effective at quieting inflammation, they can have adverse
side effects. Steroid creams may cause thinning of the skin and
decreased collagen production, while oral corticosteroids can have
more serious adverse effects.
Now, dermatologists have high hopes for a new ointment, tacrolimus
(Protopic), which was recently approved by the FDA to treat moderate
to severe eczema in patients who cannot tolerate or are not adequately
helped by standard therapies. The FDA approved tacrolimus on the
basis of three 12-week studies that found 90% improvement in about
one-third of the patients who used the medication. Two additional
one-year studies, also considered by the FDA, found that adults
who used the drug intermittently over the course of the year had
no adverse effects except temporary burning and stinging. Because
tacrolimus can increase sensitivity to ultraviolet (UV) light,
users should avoid sunlight, tanning beds, and treatment with UVA
or UVB light.
March 2001 Update
Bone Loss from Steroid Therapy
Corticosteroids are very effective in reducing inflammation. These
drugs may be taken in many forms: injected directly into a shoulder
to treat tendonitis, inhaled into the lungs to calm the inflammation
characteristic of asthma, or as creams to treat skin rashes. The
pill form (typically prednisone and Prednisolone) may be used to
treat conditions such as arthritis or lupus. One of the serious side
effects of these drugs when taken for long periods is loss of bone
mass essentially, osteoporosis.
Bisphosphonate drugs (used
to treat osteoporosis) have been shown to prevent bone loss associated
with corticosteroid therapy. A recent study confirmed that a newly
developed bisphosphonate, risedronate, helped prevent bone loss
associated with steroid use. While treatment with risedronate improved
bone mineral density, it is too early to tell for certain if it
can reduce the fracture rate for patients on steroids.