The problem with drugs for rheumatoid arthritis is that the most effective medications devastate the immune system. A new treatment will bypass this problem.
Rheumatoid arthritis (also known as RA) is a potentially devastating condition for which there is no cure. Worldwide, about one person in one hundred has the disease, but in some populations, such as Native Americans, it is much more common, up to about one in twenty. RA strikes in the prime of life, usually between the ages of 25 and 50, and about 40 percent of people who develop it become permanent disabled.
This form of arthritis most often first attacks the joints of the fingers, and then the neck and feet, although any joint can be affected. Pain at first comes and goes, but generally becomes constant and hard to control.
Most treatments for rheumatoid arthritis cause serious side effects:
- The most basic pain reliever for both rheumatoid arthritis and osteoarthritis is aspirin. It can cause stomach upset. Using too much Aspirin can result in peptic and duodenal ulcers.
- People who do not use Aspirin for arthritis pain relief typically use other NSAID drugs such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve, Anaprox, Anaprox DS, Naprelan) , and acetaminophen (Tylenol). Although they do not cause side effects in everyone who takes them, digestive upsets of various kinds are common.
- Tetracycline antibiotics are often used when RA is first diagnosed. They keep the white blood cells that damage joints from migrating to other parts of the body. They kill probiotic bacteria in the colon, and they also can cause diarrhea and susceptiblity to urinary tract infection. In rare instances, the tetracycline antibiotic minocycline can cause bluing of the enamel of the teeth.
- Steroid drugs such as Prednisone, methylprednisone, and prednisolone are relatively common in the management of RA. They work by reducing the inflammation generated by the immune system, by making capillaries less permeable so there is less swelling inside joints and less morning stiffness, and by keeping white blood cells from moving from already-inflamed joints to new sites of the disease. Steroids typically have to be discontinued because a variety of side effects including weight gain, dry skin, rashes, glaucoma, cataracts, slowing of the pulse, fluid retention, depression, and destruction of bone in the thighs and pelvis. Ironically, steroid drugs can cause joint damage as well as relieve it.
- Opioid drugs such as tramadol (Ultram) are used to manage round-the-clock pain. They frequently cause constipation, nausea, dizziness, drowsiness, and a plethora of other side effects.
- Chelating agents such as penicillamine (Cuprimine) depress the activity of the white blood cells known as T-cells. These cells, however, also fight viral infections. In addition to interfering with immune function, penicillamine causes digestive upset and alteration of the ability to taste.
- Disease-modifying anti-rheumatic drugs, also known as DMARDs, slow the progression of RA, but not without cost. One of the most commonly used DMARD drugs is methotrexate (Methotrex), which is also used to fight cancer. Methotrexate works by keeping cells from using the B vitamin folic acid. This stops the activity of white blood cells in joints, but it also interferes with the production of red blood cells, with repair of tissues, and with the normal function of the immune system. Cimzia (certolizumab), Enbrel (etanercept),Humira (adalimumab), Kineret(anakinra),Orencia (abatacept),Remicade (infliximab),Rituxan (rituximab), and Simponi (golimumab) are used with and without methotrexate to reduce the activity of the immune system, but they also cause serious side effects, including increased susceptibility to cancer.
- When these drugs don't work, doctors may prescribe other potent immune-modulating medications such as Xeljanz (tofacitinib) and Imuran (azathioprine). These tend to be drugs of last resort that have serious side effects and come with a serious price tag, about $10,000 a month before insurance and various discounts.
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The new targeted medications for RA are likely also to be extremely expensive, but they may not have the side effects of other agents.
A New Class Of Drugs For Rheumatoid Arthritis
To bypass the devastating side effects of RA treatments, doctors at the La Jolla Institute for Allergy and Immunology in California, the Wellcome Trust Centre for Human Genetics at Oxford, the Scripps Institute, and other research centers have devised a way of treating rheumatoid arthritis that does not involve reducing the effectiveness of the immune system. As lead researcher Dr Nunzio Buttini puts it, about 40 percent of people who have RA simply don't get good results with any of the drugs they are offered, and increasing the dosage only leads to infections and cancer. Instead of targeting the entire immune system, what is needed is a way to target just the immune cells in the joints themselves. Finding a switch to "turn off" the immune system only in the joint would be an ideal way to keep the disease under control.
The switch the researchers have found is an enzyme called receptor protein tyrosine phosphatase sigma, or RPTPσ. This enzyme is a protease. It dissolves proteins in the lining of the joint called the synovium. Without this enzyme, white blood cells do not attack the joint, and the disease does not progress.
The research team have developed a "decoy protein" that keeps the enzyme from attacking actual proteins in the joint, at least in mice in laboratory studies. They do not believe that their discovery will lead to drugs that make the immune-modulating drugs like Imuran and methotrexate completely obsolete, but the more toxic drugs could be used in much smaller doses. Also, this new drug could be used to treat psoriatic arthritis.
While we are all waiting on this promised wonder drug, what can people RA do to reduce their need for toxic medications?
First of all, it is important not to reduce the dosages of your medications on your own, without consulting with your doctor. If you have unpleasant side effects, by all means, let your doctor know, but don't just stop a medication. You may undo months of progress by stopping a drug too soon. There may be trade offs between side effects and RA relief that your doctor can help you achieve.
Secondly, avail yourself of simple, natural therapies that every doctor knows about and approves. Cold packs applied over the inflamed and swollen joint help it go down. They relieve pain. Just don't use a cold pack for more that 15 to 30 minutes at a time, and don't put ice directly on the skin. Conversely, use moist warmth to relieve stiffness. Don't scald your skin. It isn't necessary to burn yourself to get arthritic pain relief.
Thirdly, consider two natural therapies that your doctor is likely to know about. One is omega-3 essential fatty acids. Fish oil contains the greatest amount of EPA, which is the specific omega-3 that relieves inflammation. Other sources of omega-3's don't have as much effect on RA.
READ Natural Remedies for Arthritis
A Chinese herb known as thunder god vine may also help. It is not an herb you should take if you have osteoporosis, and its safety in pregnancy has not been determined. However, many users with RA report that it reduces inflammation and tender joints.
Sources & Links
- Pam Harrison. New Drug Target Identified for Rheumatoid Arthritis. Medscape Medical News. 5 June 2015.Photo courtesy of dvanhorn via Flickr: www.flickr.com/photos/dvanhorn/1405023682
- Mind maps by SteadyHealth.com