Breakthroughs in RA Treatment

By

Cindy Kuzma

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What RA Does to the Hands and Wrists

Inflammation from RA can make it difficult to use your hands.
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In the last decade, biologic response modifiers, or biologics, have changed what it means to have rheumatoid arthritis (RA). These medications block a specific step in the inflammation process, and can help even when other treatments have failed. Thanks to these drugs—such as abatacept (Orencia), adalimumab (Humira), and rituximab (Rituxan)—many patients have drastically reduced their symptoms. Some have even gone into remission entirely. In other words, they live their lives free from signs of the disease.

The good news doesn’t stop there. Scientists continue to study more new treatments and novel drug strategies that combine traditional medications with newer biologic therapies. The goal: Develop drugs that reduce symptoms and have fewer side effects. Read on to learn more about the latest drug approvals and new therapies on the horizon.

New Oral Medications

When you have RA, something goes awry in the way your immune system cells communicate. Enzymes called kinases play a key role in the way cells send and receive messages. New drugs attempt to block kinases to turn off these improper signals. Some experts have called this approach the next milestone in RA therapy.

The FDA approved the first of these drugs, tofacitinib (Xeljanz), in 2012. It’s known as a JAK-inhibitor because it blocks enzymes called Janus-associated kinases. Your doctor may prescribe Xeljanz if you have moderate to severe RA that hasn’t responded to other therapies. If so, you’ll likely take two 5-milligram pills per day.

Researchers are continuing to run clinical trials of SB1578, another JAK-inhibitor. And drugs that block another enzyme, spleen tyrosine kinase (SYK), have also shown promise in early research.

In some ways, these medications are similar to biologics. For instance, like biologics, they increase your risk for infections. But they work in a different way. In addition, you take them by mouth instead of injecting them.

Antibodies Fight Inflammation

When your body faces a foreign invader, your immune system produces proteins called antibodies to fight back. Infusions or injections of antibodies could also effectively treat RA. This approach reduces levels of cytokines, proteins responsible for inflammation.

Several drugs first developed to treat other diseases are now being tested against RA. Prime candidates include denosumab (Prolia), currently approved for osteoporosis, and ofatumumab (Arzerra), which treats leukemia.

Vitamin D to the Rescue

Blood tests on patients with RA frequently find low levels of vitamin D. Some doctors believe this deficiency may decrease how well RA treatment works.

Your skin absorbs vitamin D when exposed to sunlight. Fish and fortified milk also provide the nutrient. But in some cases, it’s best to take supplements. In fact, you might require an even higher dose of vitamin D than someone without RA to reach the same blood levels.

Early Detection Aids Treatment

Many medications work best when you begin taking them early in the course of RA. That way, you can prevent damage to your joints before it occurs. Besides searching for new treatments, scientists are also developing other ways to catch cases of RA before the first symptoms strike.

Soon, genetic testing and new blood or ultrasound tests could spot patients who would benefit from RA treatment before they first feel stiff or achy. In the meantime, if you develop joint pain but haven’t yet been diagnosed with RA, see your doctor as soon as possible.

Key Takeaways

  • When you have RA, something goes awry in the way your immune system cells communicate. Enzymes called kinases play a key role in the way cells send and receive messages. New oral drugs, such as tofacitinib (Xeljanz), attempt to block kinases to turn off these improper signals.

  • Infusions or injections of antibodies could also treat RA. Several drugs developed to treat other diseases could be options, such as denosumab (Prolia) and ofatumumab (Arzerra).

  • People with RA frequently have low levels of vitamin D, which may interfere with RA treatment. Sunlight, certain foods, and supplements can help.

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Jun 28, 2015

© 2015 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

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Medical References

  1. Kinase inhibition in rheumatoid arthritis: a big advance? Miossec, P. The Lancet. Feb. 9, 2013;381(9865): 429-31.
  2. Newest clinical trial results with antitumor necrosis factor and nonantitumor necrosis factor biologics for rheumatoid arthritis. Navarro-Millan. I, and Curtis, JR. Current Opinion in Rheumatology. May 2013; 25 (3):384-90.
  3. Safety profile of protein kinase inhibitors in rheumatoid arthritis: systematic review and meta-analysis. Annals of Rheumatic Diseases, Salgado, E, et al. April 18, 2013, online ahead of print.
  4. Small molecular compounds in development for rheumatoid arthritis. Vollenhoven, RF. Current Opinion in Rheumatology. May 2013;25(3):391–7.
  5. The effect of vitamin D levels on the assessment of disease activity in rheumatoid arthritis. Higgins, MJ, et al. Clinical Rheumatology. Jan. 23, 2013, online ahead of print.
  6. Medicines for Rheumatoid Arthritis: A Review of the Research for Adults. Agency for Healthcare Research and Quality. Nov. 20, 2012. (http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct...)
  7. Rheumatoid Arthritis. American Academy of Family Physicians, July 2010. http://familydoctor.org/familydoctor/en/diseases-conditions/rheumatoid-arthritis.printerview.all.htm....
  8. Medications for Rheumatoid Arthritis. Arthritis Foundation, 2012. http://www.arthritistoday.org/about-arthritis/types-of-arthritis/rheumatoid-arthritis/treatment-plan....
  9. A Closer Look at Rheumatoid Arthritis Treatments and Causes. Arthritis Foundation. 2012. http://www.arthritistoday.org/about-arthritis/types-of-arthritis/rheumatoid-arthritis/treatment-plan....
  10. New Class of Drug Would Expand RA Treatment Options. Arthritis Foundation. 2012. http://www.arthritistoday.org/about-arthritis/types-of-arthritis/rheumatoid-arthritis/treatment-plan....
  11. Precautions to Take Before Starting Biologics. Arthritis Foundation. 2012. http://www.arthritistoday.org/arthritis-treatment/medications/types-of-drugs/biologics/precautions-f....
  12. Studies Focus on Halting Rheumatoid Arthritis. Arthritis Foundation. Nov. 19, 2010. http://www.arthritistoday.org/news/early-treatment-rheumatoid-arthritis-progression103.php
  13. FDA Approves New Drug for Rheumatoid Arthritis. Arthritis Foundation. Nov. 7, 2012. http://www.arthritistoday.org/news/tofacitinib-xeljanz-approved223.php.
  14. FDA approves Xeljanz for rheumatoid arthritis. U.S. Food and Drug Administration. Nov. 13, 2012. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm327152.htm

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