Arthritis Treatment: What About the New Oral Medicines for Rheumatoid Arthritis Treatment?

Rheumatoid arthritis (RA) is the most common inflammatory form of arthritis, affecting more than two million Americans.

It is a chronic, systemic, autoimmune disease that affects not only joints but internal organs as well. Among the organ systems that can be affected are the eyes, lungs, skin, bone marrow, peripheral nervous system, heart, spleen, as well as others. Recent evidence suggests that one of the deadlier side effects of RA is the premature development of cardiovascular disease leading to an increased incidence of stroke and heart attack.

Because of the tremendous advances in treatment of RA over the last 50 years, it has been possible to take patients with this disease and put them into remission.

The first milestone came in the 1980's with the use of methotrexate. In the late 1990's biologic therapies came onto the scene. It was with this combination of therapies that talk of remission came to be a common point of discussion among rheumatologists.

Now there is more good news in that oral drugs, called signal transduction inhibitors, are an emerging therapy with a novel mechanism of action. By interfering with the transcription of important proteins inside cells, these drugs block the development of immune cell growth and survival.

By targeting a pathway called "JAK-STAT", these medicines lead to reduced inflammation and therefore less joint destruction.

Efficacy-wise, these new medicines are equivalent in their effectiveness compared to biologic drugs in patients who have failed methotrexate. Measures that have been studied include clinical markers such as the American College of Rheumatology criteria for 20/50/70 response as well as functional measurements such as the Health Assessment Questionnaire, among others.

Another pathway that has been researched with the production of an oral drug is the Syk pathway. This is another signal transduction medicine which has effects on B-cells, macrophages, and synoviocytes (cells that line the joint).

As can be imagined these new oral drugs do have potential side effects that must be more clearly elucidated.

And though available therapies are very effective, they don't lead to remission in all patients. And a significant percentage of patients develop side effects that preclude continuation of the drug, in which case remission will not be achieved.

The bright light is that ongoing research into biomarkers of disease will eventually lead to a more personalized approach so that the "right medicine for the right patient" will permit not only remission but also, possible, cure.