The Rheumatic Crash of the Silver Wave

Rheumatoid Arthritis (RA) is a chronic condition that affects between 0,5-1% of the general population. It is considered an autoimmune disorder as the inflammatory system attacks joint locations of the body — typically in the hands but also other areas such as the feet.

Enough damage will considerably lower or possibly prevent the individual’s ability to perform motor activity.

Whether the inflammatory arthritides, including RA, have a distinct presentation and course in older as compared to younger subjects as first postulated in 1941 remains unsettled. The issue has gained significant importance as the proportion of the population who are over the age of 60 continues to grow in developed nations. As multiple newer treatment strategies emerge for RA, the efficacy and safety of these in elderly populations need to be evaluated as a distinct clinical issue.
— Aviva Hopkins, MD, and Carlos J. Lozada, MD

Traditionally, treatments known as Disease-Modifying Antirheumatic Drugs (DMARDs) have been used to treat RA in order to slow the progression of the condition — with methotrexate being the gold standard. In cases of heavy or severe inflammation and/or when DMARDs fail, glucocorticoids (corticosteroids) are also used in tablet or IV form. When used over time, these drugs cause considerable damage to the body. Immunosuppressives such as cyclophosphamide are also used in cases of strong inflammation and these drugs bear considerable toxicity — including the risk of developing infertility (which is vital to understand, especially considering the majority of cases are female; 3:1 in younger-onset RA). With these factors in mind, several new treatments have been made available and the most notable are called biologic drugs. These drugs are created from a biological process rather than being chemically synthesized; most often involving recombinant DNA technology to create, for example, monoclonal antibodies and fusion proteins. An example of a monoclonal antibody used in RA is rituximab, which was created as an “antibody” to specifically target B cells — which are a vital part of the immune response. Where a healthy immune system equates to a healthy person, in the case of an autoimmune patient the inflammatory response goes out of control and must be suppressed. Taking these drugs of course can lead to a rise in the rate of infections as they very effectively do what they were made for — lowering the immune response. However, a search on PubMed or any other medical database reveals a very positive force for the usage of biologic drugs; as they are also considered safer than some traditional DMARDs. Biologics have existed for approximately 20 years, but despite evidence showing them to be significantly more effective than DMARDs, they are quite costly. Therefore, biologics are typically reserved for those patients who do not respond well to DMARDs.

If there would be a way to make these biologic drugs more cost effective, these drugs are an important milestone for an answer to worldly health with the rising rates of elderly who may potentially develop RA. Novel drugs which may be considered similar to biologics have just been introduced within the past few years and these are known as protein kinase inhibitors. More research will show if these drugs will prove to be more cost effective than the competitive biologics.

References

http://www.clinicalgeriatrics.com/articles/Rheumatoid-Arthritis-Elderly-Distinct-Clinical-Entity?page=0,2

http://www.cdc.gov/arthritis/basics/rheumatoid.htm

http://en.wikipedia.org/wiki/Biologic_medical_product

http://www.ncbi.nlm.nih.gov/pubmed/12833650

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About Adrian Levitsky

Adrian is a Research Technician and Doctoral Student at Karolinska Institutet's ClinTRID department for Inflammatory (Autoimmune) Disease research. He is a blogger for the Silverevolution initiative by ACCESS Health International. He defended his Masters thesis in Global Health at Karolinska and worked together with the CAMbrella project's Swedish team (http://www.cambrella.eu/home.php) in analyzing global key stakeholders of Complementary and Alternative Medicine (CAM) and Traditional Medicine (TM). He has an avid interest in research. Particularly, he wishes to research CAM/TM and promulgate an evidence base for the potential effectiveness of integrative care -- as this communication still is lacking globally. Adrian has a background starting as a pilot at Embry-Riddle Aeronautical University, which later evolved to studying Human Factors Psychology with a drive to understand how man and machine work together. This field often focuses heavily on research and involves testing available theories or finding new solutions to prevent work-related injuries, reduce stress, and emphasize usability/ergonomics. Teaching English in South Korea made him realize the need for innovation and imagination for all school curricula in order to solve today’s dilemmas.

One response to “The Rheumatic Crash of the Silver Wave”

  1. margareta.hl@gmail.com says :

    Adrian, verkligen välskrivet och intressant!

    19 nov 2012 kl. 11:38 skrev “WordPress.com” :

    > >

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