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Hitting Rheumatoid Arthritis Hard

Aggressive Treatment More Effective, Reduces Work Disability

By  Sid Kirchheimer WebMD Medical News Reviewed

By  , MDadvertisement

Oct. 25, 2002 -- For the best treatment in early stages of rheumatoid

arthritis, experts have two suggestions -- act quickly and see a specialist.

Both strategies help ensure that patients are more likely to get the best

type and combination of drugs found to be most effective in treating this

disabling form of arthritis, according to two studies presented at the

annual meeting of the American College of Rheumatology.

In one study, Canadian researchers found that people with rheumatoid

arthritis (RA) were more likely to receive disease-modifying antirheumatic

drugs (DMARDs) such as methotrexate -- considered the best first-line

defense in slowing disease progression -- when treated by a rheumatologist.

In tracking more than 29,000 patients over five years, they found that 80%

were given DMARD treatment by a rheumatologist, who specializes in arthritis

treatment, compared with 53% of patients seeing a general internist and 14%

seeing their family physician.

In another study, Finnish researchers found that patients who got prompt

treatment with combination DMARD therapy from rheumatologists were more

likely to return to work sooner than those receiving just one DMARD. The

patients getting combination drug therapy went on work disability one-third

less frequently than those receiving a single drug, the researchers found.

" It's pretty exciting because for years, we've known that work loss is the

most economically damaging aspect of rheumatoid arthritis, " says

Yelin, PhD, director of the Arthritis Research Group at the University of

California, San Francisco. " On average, the per-person cost of rheumatoid

arthritis in the U.S. is about $20,000 per year. Of that, about two-thirds

results from lost work wages due to disability. "

Yelin tells WebMD that both studies indicate the effectiveness of DMARD

medications, but the Finnish report also gives new credibility to a growing

trend of prescribing different types of these drugs to treat early symptoms.

" DMARDs are very effective, but since these drugs work on different

biological mechanisms, it stands to reason that combination therapy might

affect more of those mechanisms and have a greater effect, " he says.

That study backs previous findings that combination therapy helps slow

progression of the joint damage caused by the disease, but was specifically

looking at how this regimen affected patients' ability to work. " Most people

with advanced rheumatoid arthritis are unable to work at all, so early

treatment with combination therapy to slow progression could have a major

impact on future earnings, " says Yelin, professor of health policy studies

who tracks these trends.

The Canadian study is also significant because it reinforces the importance

that patients are treated with DMARDs -- which is more likely to occur under

the care of a rheumatologist, says lead researcher Diane Lacaille, MD, of

the Arthritis Research Centre of Canada at the University of British

Columbia.

" Other doctors may not be as familiar with the current guidelines of

therapy, " says Yelin. " All the drugs used to treat rheumatoid arthritis can

have serious side effects -- including DMARDs, which can cause liver

problems. But recent advances have been made in their safety. And when you

consider that nonsteroidal anti-inflammatory drugs such as -2 inhibitors

can cause stomach bleeding and don't provide the same relief,

rheumatologists are more likely to recommend DMARDs, which are much more

effective and less likely to cause liver damage than NSAIDs are to cause

stomach burning. "

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