A look into the medical treatment of rheumatoid arthritis

Written by: Professor Robert John Moots
Edited by: Bronwen Griffiths

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting approximately 1% of the population. It is characterised by inflammation of the synovial joints, such as the wrists, elbows, hips and knees. If left untreated, or inadequately treated, rheumatoid arthritis has the potential to cause disability, a reduced quality of life and a loss of work capacity. Additionally, people with RA have a lower life expectancy of 10 years, on average. Professor Robert John Moots, a leading rheumatologist, discusses how one type of medication is having a positive resurgence in treating this complex condition.

How has rheumatoid arthritis been treated in the past?

The management of RA has changed a lot in the last few decades, from controlling the symptoms to modifying disease progression. For a long time, RA was treated with glucocorticoids to control symptoms and conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) (e.g. methotrexate) to further treat the symptoms. Whilst this combination provided viable long-term treatment, many patients were unable to achieve an adequate enough response due to the adverse effects and toxicities of the medications.

Read more: Treating arthritis

What medical treatments are available now?

As our understanding of RA improved, so too did treatment. More modern treatments include the use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) which target proinflammatory cytokines. One such bDMARD is etanercept (Enbrel®) which is administered via subcutaneous injections. It is absorbed slowly, reaching peak concentrations 2-3 days later. The efficacy of etanercept in both early and longstanding RA has been shown by several controlled trials. Furthermore, the combination therapy of both etanercept with a csDMARD shows even better clinical responses and fewer cases of withdrawal due to adverse events.

Additional benefits of etanercept include:

  • No association with a higher risk of serious infection than other csDMARDs.
  • A lower risk of tuberculosis (TB) than other medications available.
  • No increased risk for malignancies compared with the general population.
  • No increased risk of lymphoma.

So, how will RA continue to be treated for many patients?

Due to the efficacy shown by etanercept, there has been a renewed enthusiasm for its prescription. Etanercept reduces disease activity and limits the progression of joint damage in rheumatoid arthritis. Taken in combination with csDMARDs, the disease-modifying effects are optimised further. Therefore, this combination of medications is likely to be a popular treatment for RA patients.

By Professor Robert John Moots

Professor Robert John Moots is an award-winning academic consultant rheumatologist who specialises in the research and treatment of inflammatory rheumatic diseases and practices at Aintree University Hospital, Liverpool. He has an international reputation for excellence both in rheumatology research and care and is an acknowledged expert in treating rheumatic diseases. He is Director of the National Centre for Behçet's Syndrome in Liverpool, and of the European League Against Rheumatism (EULAR) Centre for Excellence in Rheumatology Research, Liverpool. Professor Moots also provides regular consultancy advice to the UK National Institute for Health and Care Excellence (NICE) and works closely with the pharmaceutical Industry at a global level to improve treatment for musculoskeletal diseases. 

After training in medicine in London, Professor Moots gained his PhD at the University of Oxford. Following this, he was lecturer in Rheumatology at the University of Birmingham, before moving to Harvard Medical School, USA . He moved back to the UK to establish a new academic rheumatology unit in Liverpool. Much of his time is dedicated to research, which allows him to translate advances in understanding and treating diseases into  delivery of the highest quality state-of-the-art care. He regular receives referrals from around the UK, and many other parts of the world. He has been editor-in-chief of Rheumatology,   a trustee of the British Society for Rheumatology and helps lead the growth of rheumatology expertise in developing countries.

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