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Drug Combo Relieves Rheumatoid Arthritis

Swedish study shows more remissions with Enbrel, methotrexate

THURSDAY, Feb. 26, 2004 (HealthDayNews) -- Two drugs aimed at the body's immune system can stop the pain and joint damage of rheumatoid arthritis in many patients and can repair the damage in some, a Swedish study finds.

The combination of methotrexate, a standard treatment for years, and etanercept, a newer drug marketed as Enbrel, was more effective than either drug given alone, says a report in Feb. 28 issue of The Lancet by rheumatologists at the Karolinska Institute in Stockholm.

Progression of the disease was stopped after one year in 35 percent of the patients who got the two-drug combination, compared to 16 percent of those treated with Enbrel alone and 13 percent of those who got only methotrexate, the researchers report.

Rheumatoid arthritis is basically different from the osteoarthritis that afflicts mostly older people and is caused by wear and tear on the skeletal system. Rheumatoid arthritis can strike at any age, as the immune system mounts a mistaken attack against the body's joints.

One lesson of the study is that "timing is very important," says study author Dr. Lars Klareskog, a professor of rheumatology at Karolinska.

Drug treatment aimed at the immune system "should be instituted as fast as possible after the diagnosis of rheumatoid arthritis," because there are indications that early treatment is most effective, Klareskog says.

But he also recommends caution.

"All patients with rheumatoid arthritis should definitely not receive this combination therapy," Klareskog says. "It should be reserved for those where at least one previous disease-modifying anti-arthritis drug has failed and where there is still an unacceptable disease activity."

And the two-drug regimen used in the study is not the only possible choice, he says.

"The combination is one of several alternatives," Klareskog says. "What combination is best for the single patient is currently the choice of the single doctor. All these things are subject to continued further study."

The study is important, says Dr. John H. Klippel, president and chief executive officer of the Arthritis Foundation, because it shows "the combination of drugs is becoming increasingly important in the treatment of rheumatoid arthritis."

But much more work remains to be done, Klippel adds.

"One key message is that although a large number of patients went into remission, a large percentage continued to have active arthritis," he notes.

It still is not clear that earlier treatment can be more effective, Klippel says, since patients in the study had rheumatoid arthritis for an average of six years.

"One key question is whether this treatment used earlier, in the first year, could increase the number of people who have remissions and limit the damage done by the disease," he says.

While rheumatoid arthritis "can affect the entire age spectrum from children to older people," its incidence is highest in women between the ages of 20 and 40. Because it is an inherited genetic disease, anyone with a close relative who has rheumatoid arthritis should be alert for the joint pain and swelling of the hands and wrists caused by the disease, he says.

"It is important for these people to see a rheumatologist, a specialist in the condition," Klippel says. "A diagnosis should be made as early as possible and treatment should begin as early as possible."

More information

You can learn about the condition and drugs used to treat it at the Arthritis Foundation or the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

SOURCES: Lars Klareskog, M.D., professor, rheumatology, Karolinska Institute, Stockholm, Sweden; John H. Klippel, M.D., president and chief executive officer, Arthritis Foundation, Atlanta; Feb. 28, 2004, The Lancet
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