Future Medications & Treatment for Rheumatoid Arthritis

Rheumatoid arthritis is a painful condition in which the immune system damages the joints and connective tissues. It usually appears between the ages of 35 and 50, although it can affect people of any age, and it is estimated to affect about 1 percent of the worldwide population. The course of the disease may be mild, with only occasional flare-ups, or steadily progressive. The drugs used to treat rheumatoid arthritis include disease-modifying antirheumatic drugs (DMARDs) that slow disease progress and nonsteroidal anti-inflammatory drugs (NSAIDs). However, new and better medications and treatments are constantly being sought.

Research

• As of 2010, much research is being done on a new cytokine inhibitor. Cytokine inhibitors used to treat rheumatoid arthritis are a type of DMARD known as a biologic, which targets specific proteins. TNF inhibitors target the cytokine tumor necrosis factor alpha, implicated in inflammation, while IL-1 blockers target interleukin-1, implicated in bone and cartilage destruction. The new biologics being tested target interleukin-17. According to John Gever in a June 16, 2009 article in Medical News, research indicates that IL-17 "regulates activity of a host of immune cells, many of which are heavily involved in rheumatoid arthritis." The article reports that two investigational antibodies targeting IL-17 appeared safe and effective in separate early-stage clinical trials. The larger study, led by Mark Genovese, MD, of Stanford University, tested the antibody LY2439821 in 77 patients. The study, "LY2439821, a humanized anti-interleukin-17 monoclonal antibody, in the treatment of patients with rheumatoid arthritis: A phase I randomized, double-blind, placebo-controlled, proof-of-concept study" was published online in Arthritis & Rheumatism on Jan. 10, 2010.

Future Drugs

• A new class of DMARDs, sky kinase inhibitors, are nearly ready for the market. The company AstroZeneca announced plans to file for approval of their oral drug Fostamanitib or R788 in 2013. Sky kinase is a protein responsible for inflammation. As Denise Mann reported in Arthritis Today, a placebo study of 189 rheumatoid arthritis patients suggested that taking the new drug in combination with older DMARD methotrexate created significant improvements in the condition. The 2008 study, "Treatment of rheumatoid arthritis with a Syk kinase inhibitor: a twelve-week, randomized, placebo-controlled trial," also showed R788 to be safe, with major side-effects dosage-related and reversible, according to the article.

Other Treatments

• Joint injections, also called joint aspiration, involve injecting corticosteroids into the joints to reduce inflammation. Advantages include easy administration with a visit to the doctor's office and minimal side effects. The injections offer a far faster and more powerful form of inflammation relief than oral anti-inflammatories like aspirin and other NSAIDs, and do not irritate the stomach, according to William C. Shiel Jr., MD, FACP, FACR in MedicineNet.

Drawbacks

• Possible short-term side effects of joint injection include soreness at the injection site, aggravation of inflammation in the injected area, local bleeding and bacterial infection. Side-effects with long-term use of injection may include weight gain, cataract formation and, in rare case, damage to the bones of the large joints. Nevertheless, Dr. Shiel concludes that "it is generally felt that low, intermittent doses of corticosteroids pose little risk of significant side effects."

Significance

• With new research into the causes of rheumatoid arthritis constantly being done and new drugs in development, sufferers have reason to hope for improved treatments and a brighter future for rheumatoid arthritis.