New Treatment Guidelines for Rheumatoid Arthritis

The success of new anti-arthritis drugs and combinations of proven medicines have led the American College of Rheumatology to issue updated guidelines for the treatment of rheumatoid arthritis (RA), the first revisions to treatment recommended since 2002.

Speaking on behalf of the American College of Rheumatology, Kenneth Saag, MC, MSc, says the new guidelines come with the goal of preventing damage to arthritic joints and reducing the degree of disability caused by the disease. Saag is a professor in the Division of Clinical Immunology and Rheumatology at the University of Alabama, Birmingham. He and his colleagues co-authored the recommendations issued by the American College of Rheumatology earlier today.

Saag says the new recommendations are not intended to replace the decisions a physician must make on an individualized basis but are intended as a guide to treatment options currently available. Two of these options are DMARDs (disease-modifying anti-rheumatic drugs) and biologics, a genetically engineered type of DMARD that works in combination with previously recommended therapies. Many anti-arthritic drugs currently prescribed are done so for their ability to stop the damage caused by inflammation.

Biologics interrupt the sequence of events which, if unopposed, would lead to crippling inflammation. For example, some of the most popular new biologics make production of a protein for immunity impossible. Called anti-TNF agents, these biologics include Enbrel (etanercept), Humira (adalimumab), and Remicade (infliximab).

Some of the most important recommendations issued today include:

Leflunomide or methotrexate therapy for most RA patients.
In new RA cases or those where symptoms are becoming more severe, an anti-TNF agent can be prescribed in conjunction with methotrexate therapy.
Leflunomide, methotrexate, and biologics therapies should not be initiated on patients experiencing active bacterial infections, herpes zoster (shingles), hepatitis B or C, and tuberculosis in either the active or latent stages. Treatment should not be resumed if any of these conditions are present.
RA patients with medical histories that include multiple sclerosis, lymphoma, and heart failure should not be given anti-TNF agents.

A complete list of updated recommendations is available at the website of the American College of Rheumatology.

Filed under: Rheumatoid Arthritis