Options for treating Arthritis are increasing

May 14, 1999

Ronald Kinsey uses EnbrelBy MEG H. PARTINGTON / Staff Writer

photo: RICHARD T. MEAGHER / staff photographer

An exploding amount of research has resulted in a host of new drugs to treat the pain and swelling of arthritis.

In the last 18 months, at least seven new drugs have gained recognition, though not all have been approved by Food and Drug Administration for use on arthritis patients.

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Dr. Raymond L. Malamet of Rheumatology Consultants in Hagerstown expects even more drugs to be available in the next six to eight months.


"It's a very exciting time. What you're seeing now is really the tip of the iceberg," Malamet says.

Each new discovery is a stride in the right direction.

"Our holy grail has always been to try to look for a cure," says Dr. Nathan Wei, clinical director of Arthritis and Osteoporosis Center of Maryland in Frederick, Md. He thinks that goal is moving closer to fruition.

Injectable/intravenous options

About 1 1/2 years ago, the injectable Synvisc and Hyalgan were approved by FDA for treatment of osteoarthritis of the knee.

Both are forms of hyaluronic acid, which is produced by the body and lubricates cartilage within the joint, according to Arthritis Foundation. Osteoarthritis causes cartilage and other joint structures to break down, and, for some patients, inflammation breaks down the hyaluronic acid, which results in loss of lubrication.

Synvisc is injected into the knee joint once a week for three weeks, while Hyalgan is injected once a week for five weeks.

Malamet says the drugs help ease the pain of osteoarthritis, but have not proven to prevent further damage in the joints. He says their benefits have been felt for six months or longer.

Enbrel, also an injectable drug, was approved by the FDA in November 1998. It blocks a protein called tumor necrosis factor, which is believed to play a part in inflammation and tissue damage in those with rheumatoid arthritis, according to the foundation.

Rheumatoid arthritis results when the body's immune system causes chronic inflammation and potential joint deterioration, according to Arthritis Foundation.

Dr. Michael Rezaian, a rheumatologist in Martinsburg, W.Va., says Enbrel doesn't always work well by itself but can be beneficial to some patients when combined with Methotrexate, which he says has been used to treat rheumatoid arthritis for about two decades.

Last week FDA reported that 30 of an estimated 25,000 people using Enbrel developed serious infections, including a dangerous bloodstream infection called sepsis, and six had died.

Remicade, an intravenous medication, is being eyed as a treatment for arthritis, though it has not been approved. It has been OK'd by FDA for treatment of Crohn's disease, an inflammatory disease of the bowel.

Revolutionary options

Another newcomer is Arava, the first new disease-modifying antirheumatic drug developed specifically to fight rheumatoid arthritis in more than 13 years, according to Arthritis Foundation. It helps reduce joint pain and swelling and slows progression of joint damage, the foundation says.

The oral medication was approved by FDA in November 1998, Wei says.

"Arava and Enbrel have revolutionized our ability to control the disease," he says.

Blocking the swelling

Celebrex and Vioxx, both oral medications, are called Cyclooxygenase-2 (COX-2) inhibitors because they block an enzyme of the same name that causes joint inflammation, according to Arthritis Foundation.

While studies still are being done on the long-term effects of COX-2 inhibitors, the foundation says there are indications that they ease pain and inflammation without the ulcers or gastrointestinal side effects caused by some nonsteroidal anti-inflammatory drugs, which are aspirin-like medications.

"The big advantage of that type of medication is its safety profile," says Malamet.

Celebrex received Food and Drug Administration approval this year, says Wei, also clinical assistant professor of medicine at University of Maryland School of Medicine.

An April 20 Wall Street Journal report stated that Celebrex was associated with 10 deaths and 11 cases of gastrointestinal hemorrhages in its first three months on the market. But Malamet says about seven of the reported deaths occurred as the result of other ailments, including heart and liver disease.

Wei says whenever a drug comes on the market that has a high volume of users - 2.5 million prescriptions have been written for Celebrex, according to Arthritis Foundation - there will be some who shouldn't use it.

In April, Vioxx received a recommendation for approval by an advisory panel to FDA, according to the foundation, and is expected to hit the market soon.

Side effects

Side effects have been noted with some of the new medications, such as mild reactions where the injectable drugs enter the body, sniffles and liver abnormalities, Wei says.

Of Celebrex, Rezaian says, "most people tolerate it quite well," though some may get diarrhea while taking it. Some patients taking Celebrex and Vioxx have experienced leg swelling, he says.

Rezaian says there was concern in the medical community that Enbrel would cause upper respiratory infections, but none of his patients has had such problems.

With the new drugs, "The biggest side effect is the price," Rezaian says. They can range from less than $100 per month to $880, according to Arthritis Foundation.

Rezaian emphasizes the importance of shopping around to find the best deal on the new arthritis medications.

Even with old standbys like Methotrexate, a significant price difference exists between the pills, which are very expensive, and the liquid and injectable forms, Rezaian says.

The long-term effects of the new drugs still are unknown, Rezaian says.

related story:

-- The new drugs

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