Bone erosion, a common side-effect of rheumatoid arthritis, can be prevented by using a combination of close patient monitoring and individualized therapeutic regimens that include agents to block cytokines, block osteoclasts, or target abnormal cellular reactions.
Bone erosion, a common side-effect of rheumatoid arthritis, can be prevented by using a combination of close patient monitoring and individualized therapeutic regimens that include agents to block cytokines, block osteoclasts, or target abnormal cellular reactions.
Ellen Gravallese, MD, from the University of Massachusetts Medical School, discussed ways to treat rheumatoid arthritis and prevent bone erosion at the 2014 American Society of Bone and Mineral Research Conference in Houston, Texas.
In rheumatoid arthritis with hand involvement, articular erosions predict disability. These abnormalities can ultimately be seen as anatomic deformities, but they can also be identified on radiography when progression is subclinical. Parameters associated with increased risk of radiographic progression, include elevated inflammatory markers, bone erosion at presentation, genetic risk, the presence or absence of autoantibodies, and smoking.
Bone edema represents inflammation into the marrow space and the degree of edema correlates with inflammation and erosion. So, as inflammation improves with treatment, so does edema. Conversely, when inflammation worsens in the marrow space, it leads to erosion.
Dr Gravallese described how effective monitoring of patients using biochemical, radiologic, and clinical markers allows for individualized treatment. In the TICORA trial, rheumatoid arthritis patients were randomized to intensive management versus routine care. The study found that patients who were evaluated using objective instruments (such as clinical and radiographic findings) to assess joint inflammation, had improved outcomes.
Dr Gravalle also discussed the use of biomarkers in managing rheumatoid arthritis. For one study that showed dissociation between clinical remission and imaging, she said, “I would argue that it is not so important that osteoblasts go in and heal erosion sites, but healing erosions could be an important biomarker”.
There are currently three broad therapeutic classes that are being used to treat rheumatoid arthritis: agents can block cytokines, osteoclasts, or cells. Therapeutics that block cytokines include those that target IL-1, Tumor Necrosis Factor (TNF), and IL-6 (for example, tocilizumab). Therapeutic agents that have cellular targets include rituximab (B cells), abatacept (T cell co-stimulation) and tofacitinib.
Although these medications have complications, including infections and hyperlipidemia, targeted therapy against specific cytokines is a novel way of treating patients with rheumatoid arthritis. Clinical trials are currently enrolling patients who have previously been refractory to conventional treatment.
Specialty Pharmacists at the Forefront: Elevating Care for Rare Diseases
May 1st 2024In the US, a disease is considered rare when it affects fewer than 200,000 persons, or 1 in every 1500 individuals, with an estimated total of 25 to 30 million Americans overall living with a rare disease at any given time.
Read More
The Importance of Examining and Preventing Atrial Fibrillation
August 29th 2023At this year’s American Society for Preventive Cardiology Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award.
Listen
Diving Deep Into Specialty Pharmacy: Insights and Forecasts From IQVIA’s Doug Long
May 1st 2024Doug Long, MBA, vice president of industry relations at IQVIA, covered a bevy of stakeholder investment–related topics in his presentation at AXS24 on trends in specialty pharmacy, chief among them challenges facing the industry, obesity medications, generics and biosimilars, new product launches, and the outlook for the US market.
Read More
Promoting Equity in Public Health: Policy, Investment, and Community Engagement Solutions
June 28th 2022On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.
Listen
OptumRx’s Jon Mahrt Discusses “Irresponsible” Drug Pricing for Products With Multiple Indications
April 30th 2024When the same product comes to market with additional indications, irrational pricing decisions result in ever increasing prices instead of volume translating to lower costs, said Jon Mahrt, MBA, of OptumRX.
Read More
Forging a Patient-Centric Path to Revolutionize and Redefine Value-Based Care
April 30th 2024Optum Life Sciences and Takeda Pharmaceuticals are partnering on an innovative virtual care pilot program for inflammatory bowel disease meant to both continue the mission of the current value-based health care landscape and raise the bar for personalized care delivery optimization.
Read More