RESEARCH - Joint inflammation and destruction are separate processes in rheumatoid arthritis

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Joint inflammation and destruction are separate processes in rheumatoid

arthritis

11/6/2006

By: Reuters Health

NEW YORK (Reuters Health), Nov 6 - Combination therapy with methotrexate and

etanercept can slow radiographic progression of rheumatoid arthritis (RA)

out of proportion to its effects on disease activity, according to a report

in Arthritis & Rheumatism for October.

" Signs and symptoms of inflammation are (or can be) uncoupled from the

destructive process of rheumatoid arthritis, " Dr. Landewe from

University Hospital Maastricht in the Netherlands, told Reuters Health.

" Since the treatment possibilities of RA rapidly expand, this opens a

possibility to do a more targeted, maybe even individualized approach --

drug A to treat pain and stiffness, and drug B to stop destruction. "

Dr. Landewe and colleagues used data from the TEMPO trial to investigate the

relationship between disease activity and radiographic progression of joint

destruction in RA patients treated with methotrexate, etanercept, and the

combination of the two.

Radiographic progression rates increased with increased measures of disease

activity in the methotrexate group and to a lesser extent in the etanercept

group, the team reports, but there was no relationship between progression

rates and disease activity measures in the combination treatment group.

In fact, the researchers note, the mean radiographic progression rate was

negative for all subcategories of disease activity among patients receiving

combination therapy (but not among those receiving monotherapy with either

agent).

" We conclude from these data that there is now a good scientific rationale

for the existence of a disconnect between inflammation and radiographic

progression in patients treated with etanercept plus methotrexate and that

this observation, together with those of the previous post hoc analysis of

the data from the ATTRACT trial, suggests that this is a class-specific

effect of TNF-inhibiting drugs, " the investigators write.

" Our study has again confirmed that it is very important that we combine

anti-TNF-drugs with methotrexate, and that it is only the combination of

this drug that exerts optimal efficacy, " Dr. Landewe concluded.

" The biologic explanation for this clinical observation is, however, far

from clear, " the authors add.

By Will Boggs, M.D.

Arthritis Rheum 2006;54:3119-3125.

Last Updated: 2006-11-03 14:23:08 -0400 (Reuters Health)

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