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Treating Arthritis: Why the Truth Hurts

New treatments are in the works that might be more effective at relieving the inflammation and pain that are associated with arthritis than are existing treatments. But medications—new and old—lose their effectiveness and can’t help everyone. And false promises of “miracle” cures from nonpresciption medications persist.

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Jerry Quartley of Brooklyn, N.Y., who’s a 47-year-old technology consultant, was diagnosed with rheumatoid arthritis (RA) more than 2 decades ago. For years, prescription medications kept him in neutral. “I wouldn’t say I was getting any better, but I wasn’t getting any worse,” he says.

Newer medications, exercise and coping techniques now help Quartley to control the disease, but he also regularly writes down how he feels, which helps him and his doctor decide whether his medications need to be changed.

And they will need to be changed—that’s the reality that anyone who has RA faces. Even the most recent formulations lose their effectiveness over a few years and come with potential serious health risks.

Rheumatoid arthritis affects an estimated 1.3 million Americans, according to Arthritis Foundation. Another 33 million have osteoarthritis (OA). But Centers for Disease Control and Prevention (CDC) puts the numbers much higher. In a 2010 report that was based on a 2007–2009 survey, CDC says 50 million adults have doctor-diagnosed arthritis. That’s up from 46.4 million from a 2003–2005 survey.

What’s worse, the number of people who say arthritis affects their quality of life is on the rise. In a survey of more than 1 million people by researchers at University of Illinois and CDC, 27 percent of participants who have arthritis rated their health as fair or poor, compared with 12 percent of participants who don’t have the disease. So it’s no surprise that fighting arthritis has become a big business. At least 68 RA drugs are in development, according to Pharmaceutical Research and Manufacturers of America. Fifteen drugs are in development for OA, some of which also are meant for RA.

Treatment of arthritis is a moving target, and no magic bullets exist that are certain to hit the bull’s-eye. Consequently, unproven solutions and treatment scams abound, and Federal Trade Commission has managed to rein in only a handful of those.

RA RESPONSES. If you’re diagnosed with RA, you face an array of pharmaceutical choices but, sadly, none that guarantees relief or comes without risks. (RA is an autoimmune disease in which the body attacks itself, targeting the joints. OA, which is the so-called wear-and-tear arthritis, involves the breakdown of cartilage, which cushions the ends of bones and allows for easy movement, and also is marked by inflammation.)

Your doctor is likely to prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) for OA, or NSAIDs and disease-modifying anti-rheumatic drugs (DMARDs) for RA. These medications are intended to suppress inflammation and the resulting pain. (As inflammation is reduced, pain subsides and it’s easier to move your joints.) In the past 3 years, the choices among DMARDs that are labeled as biologics—the formulations that finally gave Quartley relief—have expanded, and more are on the way. (Of the 68 drugs that are under development, at least 29 are biologics.)

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Biologics are genetically engineered medications—altered genetic material that’s from a living organism—instead of synthesized chemicals, as are other medications. Different biologic RA medications target the body and the disease in different ways, but the goal is the same: to stop the excess activation of the immune system that leads to inflammation of the joints.

No matter which class of medications that you receive—for RA, it’s typical for doctors to prescribe both DMARDs and NSAIDs—you should know that potential side effects range from annoying, such as constipation; to deadly, such as intestinal bleeding or kidney and liver failure.

For instance, Food and Drug Administration issued a black-box warning—FDA’s most serious caution—for the biologic RA medication leflunomide (marketed by Sanofi-aventis as Arava) in July 2010 after reports of liver damage from the medication were linked to as many as 14 deaths from 2002 to 2009.

Before biologics came along, RA could be controlled in only one-third of patients, says Dr. Stanley Cohen, who is medical director of the rheumatology department at Presbyterian Hospital in Dallas. Now, 60 percent of patients can have normal lives. Many others can achieve “low disease activity,” says Dr. Yusuf Yazici, who is a rheumatologist at New York University’s Langone Medical Center.

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