New studies paint a conflicting picture of the progress being made in treating rheumatoid arthritis (RA).
One claims that RA patients today have less disability and distress than patients who were diagnosed two decades ago; while other studies question the effectiveness of new drugs and strategies being used to treat RA.
About 1.5 million Americans have rheumatoid arthritis, an autoimmune disease that attacks joint tissue and causes painful, often debilitating inflammation. As the disease progresses, many RA patients become significantly disabled and emotionally distressed.
But that gloomy outcome is changing for new patients, thanks to earlier diagnosis, treatment and more intensive therapy.
“Our research findings suggest that nowadays it is easier to live a valued life while having rheumatoid arthritis,” is what the authors conclude in a study published in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR).
Researchers in the Netherlands recruited over 1,100 newly diagnosed RA patients between 1990 and 2011. Study participants were 17 to 86 years of age, and over two-thirds were female. Each patient was assessed at the time of diagnosis and monitored for up to five years.
Researchers found that 2 out of every 4 patients in 1990 became physically disabled within four years of treatment.
But by 2011, only one out of four patients was disabled, and the percentage of patients with depression or anxiety was cut in half.
“Earlier diagnosis, more intensive interventions along with recommendations to live a full life and to be physically active may help improve daily living for those with RA,” said lead author Cécile Overman, of the Department of Clinical and Health Psychology, Utrecht University in The Netherlands.
Twenty years ago, a newly diagnosed RA patient probably would have been told to rest and limit their physical activity. New patients today are encouraged to be physically active and not live a restricted life. Remaining active, according to researchers, probably plays a role in reducing depression and anxiety.
Earlier and more intensive treatment with drugs, including the use of biological agents, may also be reducing RA disease activity.
Biologics are an expensive new class of drugs made from genetically engineered proteins derived from human genes. They are designed to inhibit parts of the immune system that cause inflammation, a central feature of rheumatoid arthritis. Treatment with biologics can cost tens of thousands of dollars a year.
But one researcher in Sweden says there’s a “big problem” with biologics – they’re often not effective in reducing RA pain.
In a study of more than 8,000 RA patients, rheumatologist John Lampa at Karolinska University Hospital found that many patients continued to experience considerable pain months after starting treatment with a biologic drug. Some even experienced more pain, even though their doctors considered the treatment successful because inflammation was reduced.
“We found that about a third of patients with good [objective] response actually have remaining pain,” says Lampa.
“We have to see this as a challenge for using other means of decreasing this pain. I think it’s important to acknowledge this at the beginning, at baseline, for every patient, and to actually make a more thorough pain analysis of more and more patients.”
New guidelines to begin treatment for rheumatoid arthritis as soon as possible may also be causing some doctors to initiate treatment for patients who would recover spontaneously. A study in Norway found that 24% of patients with swollen joints and early signs of RA went into remission without the use of any drugs.