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Rheumatoid Arthritis
The Future
The
Future
If
the next two years are as productive as the last two years, the future
for those of us with RA is looking pretty bright. There are many studies
currently underway, some looking at the genetic factors, others to
develop new and better drugs, still others are looking into non-drug
treatments.
Enbrel
and Remicade are the first drugs in a new class called biologic
response modifiers. These drugs have been developed to target and act
against specific components of the immune system. Both Enbrel and
Remicade target the TNF (tumor necrosis factor). New drugs targeting
that same factor are in development now as are other biologic response
modifiers that target other immune system components. Interleukin-12
(IL-12) is one of those components. It is a cytokine that is involved in
autoimmune diseases, they are working on developing a DMARD that can
decrease IL-12 production, thus slowing the disease process. Others are
working to target the interleukin (IL)-1alpha and IL- 1beta. The T cells
are also involved in the inflammatory processes. A vaccine that targets
these cells is being studied. Other
drugs currently being studied include new NSAIDs with less GI side
effects than even Celebrex or Vioxx.
Other
drug studies are researching new combinations of currently available
medications to achieve better results.
An
interesting non-drug therapy currently being investigated at the
University of Wisconsin involves raising the body temperature to 48.1 C
(107 F) for one hour. This is thought to induce TNF receptors and
interrupt the inflammatory immune response.
A
huge study taking place now is the North American Rheumatoid Arthritis
Consortium. This group of 12 research centers around the United States
is collecting medical information and genetic material from 1,000
families in which two or more siblings have rheumatoid arthritis. It
will serve as a national resource for genetic studies of this disease.
Scientists
are studying the confusing connection among the hormonal, nervous, and
immune systems in rheumatoid arthritis. They are exploring whether and
how the normal changes in the levels of steroid hormones (such as
estrogen and testosterone) relate to improvement, or flares of the
disease. Since RA strikes women three times as often as men, they are
looking into female and male hormones and other elements that differ
between women and men.
They
are examining why rheumatoid arthritis often improves during pregnancy.
The theory is that there are differences in certain special proteins
between a mother and her unborn child. These proteins help the immune
system distinguish between the body?s own cells and foreign cells.
Such differences, the scientists speculate, may change the activity of
the mother?s immune system during pregnancy.
With all this
research and more going on, could a cure be within our grasp? ?Cure in
our lifetime? I like the word, control, rather than cure. Take Enbrel
when it works - it's not a cure but it clearly controls the disease.?
Says Dr. Susan Hoch. ?Cure implies it is gone forever. I think control
is a more realistic goal.?
Raising my pill
bottle in a toast?here?s to a future filled with control for all of
us.
References:The
role of IL-12 in inflammatory activity of patients with rheumatoid
arthritis, Kim, W-U, et al, Clinical and Experimental Immunology
2000;119:175-181.
Clinical
trails.gov
Targeting the T cell receptor in rheumatoid arthritis.
Kotzin BL, Kappler J., Arthritis & Rheumatism 1998;41:1906-1910.
NIAMS
Handout on Health: RA
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