What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune and systemic disorder resulting in joint inflammation. An autoimmune disorder is a condition where the immune system, which protects the body from foreign substances, mistakenly attacks the body’s healthy organ(s) or tissue. In people with rheumatoid arthritis, the immune system attacks joints. This is a long-term disease that if not controlled may cause the destruction of cartilage and bone, resulting in deformation. Rheumatoid arthritis is a common disease affecting approximately 1.3 million people in the United States, it is more common in women than men, and genetics may play a role. Rheumatoid arthritis may limit the ability to do simple daily activities such as walking or opening a bottle.  Symptoms may depend on the degree of inflammation and they usually become worse in the morning. They may include, pain, fatigue, warm and swollen joints.

Although there is no cure for rheumatoid arthritis, there are drugs that may control the symptoms caused by RA and some of these drugs slow its progression. These treatments include nonsteroidal anti-inflammatory drugs (NSAIDs), conventional or biologic disease modifying antirheumatic drugs (DMARDs). Biologic DMARDs are a relatively new class of drugs that block the action of proteins produced by the body’s immune system and are involved in rheumatoid arthritis. These drugs slow the progression of joint destruction and other symptoms of rheumatoid arthritis. They are considered as last line of treatment and the FDA has approved their use in patients with moderate to severe RA who inadequately respond to traditional treatments.

Based on the American College of Rheumatology guideline, a Biologic DMARD such as a TNF-inhibitor must be added after 3 months of failed therapy (patient continues to have moderate to severe disease activity) on methotrexate monotherapy or any other DMARD combinations. If after 3 months of anti-TNF therapy, a patient continues to have moderate to severe disease activity, add or switch to another TNF-inhibitor. However, if the patient is still non-respondent to intensified dose of TNF-inhibitors after a total of 6 months, other types of biologics DMARDs are recommended. Biologics used for treatment of RA include:

• TNF-inhibitors
• Abatacept
• Tocilizumab
• Rituximab