Rheumatoid Arthritis Essay

Introduction

Rheumatoid arthritis is a common debilitating autoimmune disorder affecting men and woman of different ages worldwide. Methotrexate is a well-known initial treatment for rheumatoid arthritis, but is it enough? New studies are showing that a class of medication known as TNF-inhibitors, decreases disease progression when used in addition to methotrexate in the early treatment of rheumatoid arthritis. Of the TNF-inhibitors available, Enbrel and Humira are most commonly used because they have the same mechanism of action and only require a once a week injection which allows for better compliance. Due to having the same mechanism of action, Enbrel and Humira can be used interchangeably and therefore will both be discussed in this review.

One of the biggest challenges with the use of TNF-inhibitors in the treatment of rheumatoid arthritis is knowing when to introduce them in addition to methotrexate. Should patients be given these TNF inhibitors early in the disease or once methotrexate monotherapy fails to decrease disease activity? This is a commonly asked question among patients and physicians. The goal of using these medications together is to decrease disease activity to low activity with the possibility of remission induction. The following paragraphs will review the most up-to-date studies and provide the information necessary for understanding how to best combine these medications when treating patients with rheumatoid arthritis.

Summary of Literature Review

Studies for this review were found using the PubMed database through the medical school library at Saint Louis University. Search criteria were limited to human studies performed in the last 5 years in the English language with a focus on randomized contro...

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This study was found to have many strengths and weaknesses. The study’s main strength was that it was double-blinded, multi-centered, and placebo controlled1. Other strengths included having the same doctor follow the same patients at each encounter to record the number of tender and swollen joints found; NSAID’s were not allowed for patients to use, and analysis of results were intention-to-treat so as long as patients received one injection of Humira or placebo, they were included in the results. Weaknesses included that the study never mentioned how the two groups were randomized in the study; acetaminophen was allowed for patients to take freely; authors of the study were reimbursed; and triple therapy with sulfasalazine and hydroxychloroquine plus methotrexate were introduced in eighteen patients with Humira compared to twenty-seven patients with placebo1.