When it comes to rheumatoid arthritis, early treatment is key. As a
progressive disease with no known cure, it's crucial to begin the
process of curbing progression, relieving inflammation and limiting
joint damage from the start. Unfortunately, one of the primary therapies
used for this condition comes with several side effects and is not
effective for some patients.
The medications commonly used for
patients with rheumatoid arthritis are called disease-modifying
antirheumatic drugs (DMARDs). These drugs work by suppressing the immune
system. In people with this condition, it is believed that the immune
system malfunctions, misidentifying joint tissue as a harmful invader
and attacking it. Over time, inflammation and joint wear can lead to
disability.
There are several different types of DMARDs, each with
its own set of side effects and risks. Methotrexate is the most
popular; it's associated with adverse events ranging from upset stomach
and rash to liver toxicity and bone marrow toxicity (and birth defects
when used by pregnant women). Another common medication, sulfasalazine,
has its own very long list, ranging in severity from nausea and
tiredness to liver damage, nerve/muscle problems and infections. A third
commonly-used DMARD, leflunomide, is associated with symptoms from
diarrhea, runny nose and skin rash to signs of a serious reaction,
including troubled breathing, fever and uneven heartbeat. (These are not
complete lists of side effects.)
Despite risks, the American
College of Rheumatology guidelines for the treatment of early arthritis
recommend the use of combination therapy - treatment with two or three
DMARDs in conjunction. Because severe side effects aren't common and the
risk associated with the progression of rheumatoid arthritis are
serious, this is considered to be better than reduced medication therapy
at the outset.
However, a new study out of Belgium calls into
question those recommendations, although more research is needed to
overhaul current thinking around the condition's treatment. In the
study, 290 high-risk early rheumatic patients were randomized into one
of three treatment groups: methotrexate combined with sulfasalazine and a
high initial dose of steroids (group 1); methotrexate with leflunomide
and a moderate initial steroid dose (group 2); and methotrexate alone
with a moderate initial steroid dose (group 3). Researchers monitored
patients for disease remission and adverse events after 16 weeks of
treatment.
All three treatment groups yielded similar remission
rates - around 70% of patients qualified for remission status (it should
be noted that this rate is high compared to previous research).
However, adverse event rates varied significantly. In group 1
(combination sulfasalazine therapy), 61.2% reported some adverse event,
and 69.1% in group 2 (combined leflunomide therapy) reported side
effects. However, only 46.9% in the single DMARD group did so.
While
nearly half of patients in a treatment group reporting side effects is
nothing to sneeze at, the similar rates of remission compared to the
different rates of side effects between groups stands in support of
single DMARD use. Of course, more research is needed to validate these
results. However, the results are promising for the many rheumatic
patients who will be in search of the safest, most effective treatment
path possible.
