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Combo Drug Therapy Helps Rheumatoid Arthritis Sufferers

New study confirms a recent shift in treatments by U.S. doctors

TUESDAY, Oct. 29, 2002 (HealthDayNews) -- Treating rheumatoid arthritis with multiple drugs from the start appears to significantly reduce the number of sick days taken by people with the disease and the potential for long-term disability, a new study says.

Rheumatoid arthritis (RA) affects about 2.1 million people in the United States, compared to the 21 million affected by osteoarthritis. It is an inflammatory disease that causes pain, swelling, stiffness and loss of function in the joints. But unlike most forms of arthritis, RA usually begins when people are in their 20s or 30s. In many cases, the resulting fatigue from the illness forces people to change or quit their jobs.

"It's important to keep these people working, so they can live their lives normally," says Dr. John Klippel, medical director for the Arthritis Foundation.

Researchers from Finland presented the findings at the annual scientific meeting of the American College of Rheumatology, which concludes today in New Orleans.

The researchers tracked 162 patients for five years at the Lappeenranta Central Hospital in Finland. For the first two years, half of the patients received a combination of drugs while the other half received a single drug. Then, for the last three years, all of the patients could choose to be treated with a combination of drugs, including methotrexate and sulfasalazine.

Those who got just a single drug early on had an average of almost three times as many sick days during the five years as those with the more aggressive treatments -- 32 days a year compared to 12. While all of the patients could work at the start of the study, 29 percent of the first group had retired by the end, compared to 20 percent of the second group, says lead researcher Dr. Kari Puolakka.

More aggressive therapy not only improves the quality of life for RA patients, Puolakka says, it also "saves substantially the costs to society." Disability benefits for the single-drug group cost the Finnish government almost 900 Euros (about $900) a year, compared to just over 300 Euros (about $300) a year for the group that received a mix of medications, she says.

In America, the study confirms a recent shift in treatment methods from a single drug to a combination of drugs, Klippel says.

"Over last three to five years, doctors have started using more and more of this type of therapy. This study provides some important evidence for us that it works," he says, adding that about 60 percent to 80 percent of U.S. rheumatologists now use this combination therapy.

A study like the Finnish one would be very difficult to perform in the United States, Klippel adds. Besides tracking a large group of patients for five years, the researchers had to collect accurate information about their missed work days. Because Finland has nationalized medicine, the study is much more reliable, he says.

The most important finding of the study, Klippel says, is that the type of combination therapy used is already showing a major impact on a patient's quality of life five years later. This bodes well for a patient's next 10, 15 or 20 years, he says.

"For most people, the symptoms are improved but not completely removed. But they have much more control over their lives," Klippel says.

Rheumatoid arthritis has several characteristics that make it different from other kinds of arthritis. For example, rheumatoid arthritis generally occurs in a "symmetrical pattern." This means that if one knee or hand is involved, the other one is also.

The disease often affects the wrist joints and the finger joints closest to the hand, although it can also affect other parts of the body besides the joints. In addition, suffers may have fatigue, occasional fever and a general malaise, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

What To Do

To learn more about rheumatoid arthritis, visit the National Institutes of Health or the National Library of Medicine.

SOURCES: Kari Puolakka, M.D., department chief, Lappeenranta Central Hospital, Finland; John Klippel, M.D., medical director, Arthritis Foundation, Atlanta; Oct. 25-29, 2002, American College of Rheumatology annual meeting, New Orleans
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