Current and emerging therapies for rheumatoid arthritis, with a focus on infliximab: Clinical impact on joint damage and cost of care in Canada

Background: Rheumatoid arthritis (RA) is a physically debilitating disease that places an enormous burden not only on individuals and their families b ut also on the economy. Affecting similar to1% of the Canadian population, RA is characterized by pain and swelling of joints. Without effective treat ment. RA results in joint destruction that often requires surgery. Objective: This review summarizes the effect of current and new RA treatmen ts on joint damage, with a focus on infliximab. The health-economic repercu ssions and potential impact of arresting the joint destruction of RA are di scussed. Methods: Information for inclusion in this review was identified through se arches of the MEDLINE and HealthStar databases from 1995 to 2000. Search te rms included rheumatoid arthritis, treatment guidelines, economics. and ind ividual drug names. Results: Standard initial RA drug therapy has been aimed at reducing pain a nd inflammation, whereas use of the more potent disease-modifying antirheum atic drugs (DMARDs) has been reserved for later stages of disease. More agg ressive RA treatment involves introducing DMARDs at the earliest stage. The largest single direct cost of RA involves hospital admissions for the corr ection of joint deformities. Among newer therapies, the anti-tumor necrosis factor-alpha agent infliximab has been shown to arrest radiographic measur es of disease progression. Conclusions: With early and aggressive treatment involving new drugs and dr ug combinations, it may be possible to ameliorate the physical, social, and economic effects of R.A.