Patients suffering from rheumatoid arthritis often experience chronic, disabling joint pain that can greatly affect movement and activities of daily living. To combat this disease, doctors utilize a combination regimen of various medications – including NSAIDs and DMARDs (per this article on treatment), as well as immunosuppressants, corticosteroids and biological agents – in addition to non-pharmacological treatments such as diet, exercise and physical therapy. Below we discuss the state of current research involving potential new remedies for people with this condition.
Are there any research studies or clinical trials seeking better therapies for rheumatoid arthritis?
As a prevalent condition worldwide, rheumatoid arthritis attracts quite a bit of interest from the research community, which can be viewed on sites such as Arthritis Today. This is evidenced by pharmaceutical innovations over the past two decades that include advanced immunosuppressants and biologics, as well as research that has provided enhanced understanding of more standard therapies according to a six-year Swedish study and a two-year US study, allowing therapeutic refinements. One need only search briefly online to find numerous examples of recent studies and papers on the subject, for example this treatment approach write-up from Mayo Clinic doctors.
One relatively new and very promising area of investigation has been that of “kinase inhibitors”, which target specific enzymes (kinases) that normally produce “cytokines”, which are inflammatory mediators. The end result of blocking these kinases is a reduced inflammatory response. The reason there is such interest in this class of drugs is that unlike previous biologics, which use molecules too large to be administered orally (requiring intravenous or subcutaneous routes instead), these are small enough to allow for oral administration. This is an obvious plus in terms of ease of use and patient compliance. While not perfect, researchers are hopeful that these medications will allow sufferers to achieve a new level of pain reduction and comfort.
In addition to more traditional types of therapy, the last few years have also seen a rise in patients seeking to augment such treatment regimens with alternative or complementary remedies. Some of these are more successful and/or backed by science than others.
Clinical trials are an essential part of the research paradigm, and for a disease such as rheumatoid arthritis (i.e., common and debilitating) there are almost always several investigations taking place at any given time, as well as many planned for the future. There are several excellent clearinghouses online with comprehensive databases of trials looking for participants nationwide, and there seems to be no lack of opportunities for those interested in learning more on CenterWatch.com and ClinicalTrials.gov.
If doctors think current treatments are effective for rheumatoid arthritis, what criteria is used to determine that?
While rheumatologists are always hopeful that more effective treatments, or perhaps even a cure, will become available for rheumatoid arthritis, the current therapies used are all successful and impactful to some extent (and unfortunately the best we have at the moment). The specific treatment plan prescribed depends on the patient’s individual signs and symptoms, as well as past therapeutic successes or failures, which can vary quite a bit in rheumatoid arthritis, as with many autoimmune disorders.
Once a doctor and patient settle on an acceptable regimen, the patient’s symptom profile is monitored to determine whether the current therapies are working, in terms of pain reduction, increased mobility and capacity for dealing with flares. Additionally, doctors look for radiographic evidence of retarded disease progression as a sign of successful treatment. As much as possible, physicians will seek to tweak these medications – based on these observations – in order to provide maximum relief while accounting for possible adverse effects. Thankfully, while not always a magic bullet, there are now a host of different medications and treatments available to help fight rheumatoid arthritis and its complications.
There are different protocols and algorithms that doctors use to determine the best course of treatment in patients with rheumatoid arthritis, based on empirical and anecdotal evidence. As per the Hippocratic oath, these seek to prescribe the best therapies that will manage the disease, while not subjecting the person to untenable side effects, with the additional goal of using the least potent method that will still accomplish the job.
Questions for your doctor:
- Are you or any colleagues currently involved in research in rheumatoid arthritis?
- Where can I find the latest reliable information on current research efforts into rheumatoid arthritis treatment advances?
- Where do you suggest I look if I want to participate in a clinical trial?
- If my symptoms aren’t satisfactorily controlled on my current medication regimen, what else can we try?
- Are there other safe and effective therapies available elsewhere that aren’t yet approved in the U.S.?
About the Author
Dr. Rothbard is a professional medical writer and consultant based in New York City, specializing in medical education articles targeted at a variety of audiences, from children through clinicians. After leaving medicine, he worked as a biology and medical science educator for several years, before deciding to pursue writing full-time. He may be reached at [email protected].