Drug Therapy for Rheumatoid Arthritis in Adults: An Update - Executive Summary | AHRQ Effective Health Care Program

open here or see below please ►
Drug Therapy for Rheumatoid Arthritis in Adults: An Update - Executive Summary | AHRQ Effective Health Care Program

Executive Summary – Apr. 24, 2012

Drug Therapy for Rheumatoid Arthritis in Adults: An Update

Formats

• View PDF (PDF) 357 kB  
• Help with Viewers, Players, and Plug-ins

This topic includes two executive summaries:

• Drug Therapy for Rheumatoid Arthritis in Adults: An Update
• Drug Therapy for Psoriatic Arthritis in Adults: Update of a 2007 Report

Table of Contents

• Background
• Objectives
• Analytic Framework
• Methods
• Results
• Discussion
• Abbreviations
• References
• For More Copies
• Full Report

Background

Rheumatoid arthritis (RA), which affects 1.3 million adult Americans, is an autoimmune disease that involves inflammation of the synovium (a thin layer of tissue lining a joint space) with progressive erosion of bone leading in most cases to misalignment of the joint, loss of function, and disability. The disease tends to affect the small joints of the hands and feet in a symmetric pattern, but other joint patterns are often seen. The diagnosis is based primarily on the clinical history and physical examination with support from selected laboratory tests. Treatment of patients with RA aims to control pain and inflammation and, ultimately, the goal is remission or at least low disease activity for all patients. Available therapies for RA include corticosteroids, oral disease-modifying antirheumatic drugs or DMARDs (hydroxychloroquine, leflunomide, methotrexate [MTX], and sulfasalazine), and biologic DMARDs (five anti-tumor necrosis factor drugs [anti-TNF]: adalimumab, certolizumab, etanercept, golimumab, infliximab; and others including abatacept, anakinra, rituximab, and tocilizumab).
Treatment strategies for RA continue to evolve. Early use of DMARDs is considered crucial to avoid persistent and erosive arthritis. Clinicians frequently start treatment regimens with oral DMARD monotherapies and adjust dosages as appropriate to achieve a low disease activity or remission. Clinical experience supports the use of MTX as the oral DMARD of choice unless there are contraindications (e.g., liver impairment, alcohol abuse, pregnancy, lung disease). Experts have not arrived at consensus about the comparative effectiveness of corticosteroids, oral DMARDs, and biologic DMARDs. More importantly, it is unclear how the effectiveness and safety of different types of combination therapy compare, for example, oral DMARDs with corticosteroids, oral DMARDs with biologic DMARDs, or a triple combination of corticosteroids, oral DMARDs, and biologic DMARDs. In addition, there is debate about how early in the disease process combination therapy should be initiated. Many questions remain about the risks of these agents across a spectrum of adverse events, from relatively minor side effects such as injection site reactions to severe and possibly life-threatening problems such as severe infections or infusion reactions. Finally, very little is known about the benefits or risks of these drugs in different patient subgroups, including ethnic minorities, the elderly, pregnant women, and patients with other comorbidities.