Lifestyle Changes and Drug Therapy Urged for Arthritis
Portyansky, Elena, Drug Topics
For the 40 million arthritis sufferers, "exercise" was an important part of the prescription dispensed by the Arthritis Foundation at a recent news conference held at its New York chapter under the sponsorship of Wyeth-Ayerst Laboratories.
A workout is a definite plus, with the potential to decrease the need for analgesics in osteoarthritis, but it's no salvation. "The odds are that patients with inflammatory types of arthritis," such as rheumatoid arthritis (RA), "will still require the same medication levels," commented Ginger Constantine, M.D., senior director of metabolic/ endocrine, CNS, musculoskeletal division, clinical affairs department, Wyeth-Ayerst.
Drug therapy, particularly in chronic, progressive RA, continues to be the bottom line in treatment. And drug treatment has become more aggressive, with the reconstruction of the once-worshiped RA treatment pyramid. For years, clinicians followed the pyramid scheme calling for initial treatment with nonsteroidal antiinflammatory drugs (NSAIDs), such as Wyeth's recently launched Lodine XL (etodolac extended-release), exercise, and rest. A disease-modifying antirheumatic drug (DMARD) was held off and added only when RA progressed-which was already three to four years into the course of the disease, explained Doyt L. Conn, M.D., senior v.p. of medical affairs, Arthritis Foundation. Methotrexate was at the very top of the pyramid, representing the last resort.
But "we have learned since then that in many RA patients, the damage to their joints is done by active inflammation in the first two to three years of the illness," Conn said. He urges the use of DMARDs such as methotrexate or hydroxychloroquine, or DMARD-combos early on in treatment. "With this strategy, we can really modify the course of the disease, limit its impact, and reduce destruction and deformity of joints," he declared. …