Abstract
Background: Being the commonest rheumatoligical disease the treatment of rheumatoid arthritis requires optimisation. The use of disease modifying medications in rheumatoid arthritis needs particular emphasis. Many patients presents late with deformities resulting in significant morbidity.
Methods: We conducted a prospective study involving 60 patients with active rheumatoid arthritis and a double blind comparison sub study in which outcome of treatment of 35 patients were analysed between methotrexate and leflunomide.
Results: The 60 patients studied were predominantly women (mean age, 52 years; mean disease duration, 4.5 years) The ACR response for patients receiving leflunomide treatment was 52% and that of methotrexate treatment was 48%. They were statistically equivalent, with mean time to initial response at 8.2 weeks for patients receiving leflunomide vs 9.1 weeks for patients receiving methotrexate therapy. X-ray analyses demonstrated less disease progression with both arms of the study. Common adverse events for patients receiving leflunomide treatment included gastrointestinal complaints, skin rash, and reversible alopecia.
Conclusions: Current treatments for rheumatoid arthritis (RA) include nonsteroidal anti-inflammatory drugs (NSAIDs), low-dose steroids, and disease-modifying antirheumatic drugs (DMARDs). No currently available medication is uniformly effective, and all may cause significant adverse effects. The active control drug for this study, methotrexate, is considered to be the "gold standard" DMARD for the treatment of RA.
Clinical responses following administration of leflunomide, a relatively new therapeutic agent for the treatment of RA, were statistically equivalent to those with methotrexate treatment. Both treatments improved signs and symptoms of active RA, delayed disease progression as demonstrated by x-ray films, and improved function and health-related quality of life.
Keywords: Rheumatoid arthritis, DMRD, Leflunomide, Methotrexate.
References
1. Silva HTMorris RE Leflunomide and the malanonitriloamides. Am J Med Sci. 1997;313289- 301.
2. Ward MMFries JF Trends in antirheumatic medication use among patients with rheumatoid arthritis, 1981-1996. J Rheumatol. 1998;25408- 416.
3. Firestein GS. Evolving concepts of rheumatoid arthritis. Nature 2003;423:356-361
4. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/ European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;69:1580-1588
5. Choi HK, Hernan MA, Seeger JD, Robins JM, Wolfe F. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 2002;359:1173-1177.
6. O'Dell JR. Treatment of rheumatoid arthritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley's textbook of rheumatology. 9th ed. Philadelphia: Elsevier, 2013:1137-60..
7. Singh JA, Furst DE, Bharat A, et al. 2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken)2012;64:625-639.
8. Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2010;69:964-975[Erratum, Ann Rheum Dis 2011;70:1519.]
9. Lipsky PE, van der Heijde DMFM, St Clair EW, et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. N Engl J Med 2000;343:1594-1602.
10. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315-324
11. Felson DT, Anderson JJ, Boers M, et al. Preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum 1995;38:727-735
12. Olsen NJ, Stein CM. New drugs for rheumatoid arthritis. N Engl J Med 2004;350:2167-2179
13. Krishnan E, Fries JF. Reduction in long-term functional disability in rheumatoid arthritis from 1977 to 1998: a longitudinal study of 3035 patients. Am J Med 2003;115:371-376
14. Tsakonas E, Fitzgerald AA, Fitzcharles MA, et al. Consequences of delayed therapy with second-line agents in rheumatoid arthritis: a 3 year followup on the Hydroxychloroquine in Early Rheumatoid Arthritis (HERA) study. J Rheumatol 2000;27:623-629.
15. Moreland LW, O'Dell JR. Glucocorticoids and rheumatoid arthritis: back to the future? Arthritis Rheum 2002;46:2553-2563.
Corresponding Author
Ajith S.N
Department of Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
Phone (Mobile) No.: +919446551478, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.169
