Rheumatoid Arthritis Overview
The FDA has launched an investigation into the safety of rheumatoid arthritis medications following a clinical trial that raised concerns over potentially dangerous side effects. Primarily, these concerns are over a medication known as tofacitinib, manufactured and marketed by Pzifer under the brand name Xeljanz.
First approved in 2012, Xeljanz was developed for the treatment of rheumatoid arthritis in adult patients who failed to respond to first-line treatments such as Otrexup, Xatmep, and Trezall (methotrexate). The study that has raised safety concerns was required as one of the conditions for market approval and should be completed by the end of this year.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is an autoimmune condition, resulting in painful inflammation and swelling of the joints, particularly those of the hands and feet. Rheumatoid arthritis medications can help alleviate symptoms in 75 percent of victims
Symptoms
The most common symptoms of RA are joint pain and stiffness, usually upon awakening in the morning or after other prolonged periods of inactivity. Patients may lose range of motion as fluid build-up in the joints lead to swelling; eventually, the disease can lead to joint deformity and immobility. Other symptoms may include general weakness and fatigue, loss of appetite and weight loss, and low-grade fever.
Risk Factors
Conditions that can increase the risk of developing rheumatoid arthritis include:
- Gender and Ethnicity: Women of European ancestry are up to three times more likely to develop RA
- Genetics: RA tends to run in families
- Age: although RA can strike at any age, it typically develops around age 45-50
- Tobacco Use: smoking has been identified as a risk factor, particularly in those with a genetic predisposition
- Obesity: Excess weight, particularly in women under age 55, are at higher risk for RA
- Environmental Toxins: Exposure to substances such as asbestos and silica appear to increase the risk of RA
Complications
Side effects of rheumatoid arthritis medications notwithstanding, patients suffering from the disease are at elevated risk of carpal tunnel syndrome, cardiovascular disease, respiratory distress, and lymphoma.
Treatments
In addition to rheumatoid arthritis medications, treatments include:
- lifestyle changes, including diet, rest and cessation of tobacco use; some patients experience relief by eating foods rich in omega-3 fatty acids and eliminating red meat.
- physical or occupational therapy, including a guided exercise regimen that includes stretching.
- Surgery, although this is generally considered a last resort. In some cases, total knee arthroplasty or hip replacement is indicated. For smaller joints, such as those of the hands and feet, fusing or removing the joints can help relieve the pain.
Rheumatoid Arthritis Medications
Drug therapy for RA falls into three categories:
- pain relievers, including non-opioid analgesics such as Tylenol and Ultram, opioids, or a combination of the two
- anti-inflammatories, including Celebrex (celecoxib), Aleve and simple aspirin
- immunosuppressants, which can be either biologic agents (Humira, Actemra, et. al) or corticosteroids
Janus kinase (JAK) inhibitors are the newest class of rheumatoid arthritis medications. Xeljanz is the first drug of this type. At higher doses (10 milligrams twice per day), this drug causes serious, life-threatening side effects that include pulmonary embolism, infections, and cancer.
