New drugs in the treatment of rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterised by potentially deforming symmetrical polyarthritis and extra-articular features, which may affect the lungs, kidneys and vasculature. Disease progression results in joint damage, deformation and loss of function, all of which mean disability and a reduction in quality of life.
RA affects approximately 1 per cent of the population. The estimated cost of RA to the National Health Service is £240–600m per year and may be as high as £1.3bn.1 The social cost of RA is also considerable, with significant numbers of patients being unable to work, requiring residential home care and having reduced life expectancy.1 Data from the late 1980s suggest that 80 per cent of patients will be disabled after 20 years, although, since the approach to treatment of RA has become more aggressive since that time, the percentage may now be much less.2
The initial presentation of newly diagnosed RA patients can be roughly categorised into three distinct groups. The first group, comprising 75 per cent of patients with RA, have a slow onset of disease, approximately 20 per cent have intermediate disease activity and the remaining 5 per cent of patients have a rapidly debilitating illness. Patients in the last category have aggressive disease which is associated with rapid destruction of the joints.
Response to treatment
Response to treatment in RA patients can be assessed using a number of subjective and objective markers of disease.
One way of measuring response to therapy is to use the American College of Rheumatology (ACR) guidelines. Patients are scored using various criteria and scores are compared to obtain an improvement in their symptoms. This is referred to as the ACR response (see Panel, p17).3
For the purposes of clinical trials, the ACR response is usually used to describe how many patients have a 20 per cent, 50 per cent or 70 per cent improvement in their overall scores which equate roughly to the patient’s ability to carry out activities of daily living.
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Citation: Hospital Pharmacist URI: 10975288
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