Biologics Transform RA Outlook

[crimson]

When MedPage Today contacted Joan Von Feldt, MD, to talk about the changes she'd witnessed in rheumatoid arthritis (RA) care in the past 25 years, she offered one piece of advice:

"I hope, in your article, you reflect the excitement that rheumatologists have in managing this disease, because it's so much more satisfying," said Von Feldt, a rheumatologist at the University of Pennsylvania.

In 1984, the outlook for newly diagnosed RA patients was grim: a regimen of often toxic drugs that might slow the onset of crippling pain, but not for very long. Younger women were advised to forget about having children because they probably would be too disabled for the rigors of motherhood. The best outcome for many patients was joint fusion or replacement surgery.

"Our orthopedic surgeon came around to our offices two or three times a week to just kind of check in," Von Feldt recalled.

Today, although disease flares and progression can't be prevented entirely, doctors can now tell patients to expect long periods of remission and the availability of many effective, nonsurgical treatment options when their current regimens begin to fail.

Dennis Boulware, MD, a rheumatologist at the University of Alabama at Birmingham, said he tells new patients that they can live normal lives.

"I would also mention one of my former patients with significant rheumatoid arthritis who ran and completed a marathon after we got her condition under control."

http://www.medpagetoday.com/Rheumatology/Arthritis/17745

[kageyd]

Thanks, Crimson. The current edition of the AARP journal also has a good article on biologics. They have the potential to do tremendous good, and they are constantly being refined. The problem right now is that the potential side effects can be quite serious, and unfortunately those side effects may not appear until several years of use have passed, at which time damaging, and sometimes irreversible, illnesses have developed. I've been reading a little about Humira, and find myself appalled at how many people have reported serious damage to other tissues (along with, in most cases, improvement in RA). On the other hand Enbrel, especially, on this forum seems to be a great find, and I'm not sure that anyone here has reported a truly negative serious side effect (such as eye damage, or lung damage, or certain blood cancers..). I'm not at the stage where my rheumy is considering biologics (and hope I never get there!), but it won't be an easy decision to make, and at best it will take a very vigilant monitoring of all body systems to forestall some of the potential side effect problems. I'm looking to this forum for the most up to date information as provided by our wonderfully caring members. I'll try to do my share. Kageyd

[adhityaen]

"Parenteral gold salts . . . are the preferred choice for first-line remission inducing drug therapy," according to a 1985 review article on RA management in the American Journal of Medicine.

Most patients would first receive either steroids or nonsteroidal anti-inflammatory drugs (NSAIDs), but since these do not slow destruction of the joints, physicians would eventually prescribe gold or other agents believed to modify the disease process.

I really puzzled to read that in 1985, RA patients were treated with parenteral gold salts for remission. Do anyone know whether it's still prescribed? I doubt and wonderful article with great insights.