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A Look at Complications After Total Joint Arthroplasty

Results of a meta-analysis suggest that patients with rheumatoid arthritis (RA) appear to be at higher risk for dislocation following total hip arthroplasty than those with osteoarthritis who have these procedures (odds ratio, 2.16). Patients with RA also had a greater risk for infection following total knee arthroplasty. Abstract: Arthritis & Rheumatism, December 2012....

Updated Guidelines for RA Treatment

In 2008, the American College of Rheumatology (ACR) issued guidelines for the use of non-biologic and biologic treatments in rheumatoid arthritis (RA). Much has changed in the years since the last recommendations, with the availability of new drugs and increased experience with the older agents. The ACR guideline update, which was published in the May 2012 issue of Arthritis Care & Research, focuses on early treatment, special considerations for high-risk patients, and screening for tuberculosis. “The 2012 update re-emphasizes the importance of more aggressive treatment in early RA.” The ACR update re-emphasizes the importance of aggressive treatment in early RA. In addition to better outcomes, early intensive treatment can help patients maintain physical function and quality of life. Prevention is critical because joint damage resulting from RA is permanent once it occurs. It should be noted that the updated recommendations focus on common clinical scenarios. They should be used as a guide for clinicians with the clear understanding that the best treatment decisions can only be made by having collaborative dialogue with patients. For each patient, physicians must consider: The risks and benefits of treatment. Comorbidities and concomitant medications. Patient preferences. Practical economic considerations. Rheumatoid Arthritis Treatment Recommendations The goal of early RA treatment is for remission or at least low disease activity. For patients who have been symptomatic for 6 months or less, the usual approach should be disease-modifying antirheumatic drug (DMARD) monotherapy. If disease activity is moderate or high and patients have poor prognosis, combination DMARD therapy can be tried. If disease activity is high in early RA and the prognosis is poor, an anti-tumor necrosis factor...

FDA Approves Xeljanz for Rheumatoid Arthritis

The U.S. Food and Drug Administration today approved Xeljanz (tofacitinib) to treat adults with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response to — or who are intolerant of — methotrexate. RA is an autoimmune disease, in which the body’s immune system mistakenly attacks healthy tissue leading to inflammation of the joints and surrounding tissues. According to the Centers for Disease Control and Prevention, RA affects an estimated 1.5 million Americans. Xeljanz, a pill taken twice daily, works by blocking molecules called “Janus kinases,” which are important in the joint inflammation of RA. “Xeljanz provides a new treatment option for adults suffering from the debilitating disease of RA who have had a poor response to methotrexate,” said Badrul Chowdhury, M.D., Ph.D., director of the Division of Pulmonary, Allergy, and Rheumatology Products in the FDA’s Center for Drug Evaluation and Research. Xeljanz is being approved ahead of the product’s prescription drug user fee goal date of Nov. 21, 2012, the date the agency was scheduled to complete review of the drug application. The safety and effectiveness of Xeljanz were evaluated in seven clinical trials in adult patients with moderately to severely active RA. In all of the trials, patients treated with Xeljanz experienced improvement in clinical response and physical functioning compared to patients treated with placebo. The use of Xeljanz was associated with an increased risk of serious infections, including opportunistic infections (infections that occur primarily when the immune system is suppressed), tuberculosis, cancers and lymphoma. Xeljanz carries a Boxed Warning regarding these safety risks. Xeljanz treatment is also associated with increases in cholesterol and...

Rheumatoid Arthritis & Physical Activity

Researchers from Chicago have found that too few adult patients with rheumatoid arthritis (RA) appear to be physically active. The study showed that 42% of adults with RA in the analysis were inactive. A lack of motivation and a lack of strong beliefs in the benefits of physical activity accounted for nearly 65% of the observed excess inactivity. The authors noted that interventions should be developed to increase motivation and encourage stronger beliefs in the benefits of physical activity for RA sufferers. Abstract: Arthritis Care & Research, January 25,...

An RA Update

In the June 15, 2008 issue of Arthritis Care & Research, the American College of Rheumatology (ACR) published updated guidelines on the use of nonbiologic disease-modifying anti-rheumatic drugs (DMARDs) for the treatment of rheumatoid arthritis (RA). The guidelines also provide recommendations for the use of biologic agents for the first time. The ACR recommendations are the culmination of a systematic review of evidence that updates guidelines that were previously released in 2002. They were developed for specialists who are familiar with assessing RA activity and disease severity. Assessing DMARD Therapies  The ACR recommendations provide evidence-based suggestions for when to initiate biologic and nonbiologic DMARDs. Recommendations should be based on the level of disease activity, duration of RA, and factors that pertain to prognosis. Nonbiologic DMARD combinations recommended in the guidelines and used most commonly include methotrexate plus hydroxycholoroquine, methotrexate plus sulfasalazine, methotrexate plus leflunomide, sulfasalazine plus hydroxychloroquine, and sulfasalazine plus hydroxychloroquine followed by methotrexate. Monotherapy with either methotrexate or leflunomide, however, is recommended as initial therapy for most patients with RA for all disease durations and degrees of disease activity. Biologic therapies have assumed a significant role in the treatment of RA, particularly for patients with severe RA and high disease activity after failure of nonbiologic DMARDs. The updated guidelines recommend appropriate times to consider biologics and provide safety considerations that should be recognized when using these therapies. Biologic DMARDs are separated according to disease duration (less than 6 months and 6 months or longer). Patients with early RA and only low or moderate disease activity are not considered candidates for biologic therapy....
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