Arthritics, Rejoice

By Ian K. Smith, M.D.

Forty million Americans suffer from arthritis, the painful, often debilitating disease that can affect every joint in your body. Actually, it isn't just one disease. Arthritis is a whole class of illnesses that comes in more than a hundred varieties. About 20 million people in the U.S., for example, have been diagnosed with osteoarthritis, a degenerative disease in which cartilage that cushions the joints erodes, leading to painful bone-on-bone contact. And 3 million or so more have rheumatoid arthritis, a chronic inflammation of the joints that causes pain, stiffness, swelling and loss of function.

These numbers will rise dramatically over the next few years, both because the baby-boom generation is aging and because the elderly are living longer. Unfortunately, the standard treatment for arthritis is the nonsteroidal anti-inflammatory drugs, or NSAIDS, a group that includes aspirin and ibuprofen. Too often these medicines have unacceptable side effects, including internal bleeding and ulcers.

Now some new drugs are generating a lot of medical buzz, including a special session at the recent meeting of the American College of Rheumatology in Boston and several reports in last week's Journal of the American Medical Association. In one study, researchers compared Celebrex, one of the so-called COX-II inhibitors (they attack an enzyme, COX-II, that promotes inflammation) to naproxen, a commonly used NSAID. Both reduced the symptoms of rheumatoid arthritis. But while 26% of the naproxen patients got an ulcer in either the stomach or the small intestine, ulcers struck only 4% to 6% of those taking Celebrex.

Another new drug, called Remicade, approved just a few weeks ago by the FDA, is also the focus of a JAMA report. A medication called methotrexate has long been the treatment of choice for rheumatoid arthritis. It is not an NSAID, so it doesn't cause ulcers--but for many patients it stops working after a while. More than half the people who took Remicade along with methotrexate had at least a 20% reduction in arthritis symptoms, according to the study.

With such great advantages, you might think arthritis sufferers would besiege their doctors and pharmacists for these medicines. But there is one very serious side effect to all of them: the expense. Traditional NSAIDS can cost as little as 20[cents] a pill; the new COX-II inhibitors, by contrast, will set you back about 15 times as much. As for Remicade, the first year's supply is expected to run about $10,000.

In some cases, insurance will pick up the tab, and Remicade, at least, qualifies for Medicare reimbursement. But coverage probably won't be universal. Some firms could make doctors prescribe cheaper, though more problematic, alternatives. For some patients, the pain of arthritis will be compounded by the pain of knowing there's help just beyond their reach.

For more information, visit the Arthritis Foundation at www.arthritis.org You can e-mail Dr. Smith at ianmedical@aol.com