Since Carol Williamson was diagnosed with rheumatoid arthritis in 1987, she has tried almost every drug available. But "nothing really helped that much," says the 70-year-old retired secretary from Sugarland, Tex. The pain in her fingers and wrists got so bad that she had to give up driving and even had trouble opening a soda can. "I had just about given up hope," Williamson says. Then, two months ago, she started taking a new anti-inflammatory drug, Enbrel. Today, she has little pain, can use her hands freely, and plans to resume driving.
Enbrel represents one of a number of important advances in the treatment of arthritis, a condition that affects 43 million Americans--one in six. "We haven't had a new drug for arthritis in over a decade, and this year we have several," says Dr. David Fox, chief of the rheumatology unit at the University of Michigan Medical School in Ann Arbor.
The new medicines are the result of long-running studies into the two most common forms of the disease: osteoarthritis and rheumatoid arthritis. Osteoarthritis occurs when the cartilage in a joint deteriorates, causing the bones that meet there to rub against each other. Rheumatoid arthritis results from an improper immune response that chronically inflames and eventually destroys joints. Symptoms for both include joint pain and stiffness, sometimes with unsightly, painful nodules and swelling.
The latest drug to hit the market is Celebrex, approved Dec. 31 by the Food & Drug Administration for both forms of arthritis. Celebrex is the first of a class of nonsteroidal anti-inflammatory drugs known as COX-2 inhibitors. They act by blocking enzymes involved in joint inflammation while sparing COX-1 enzymes that protect the gastrointestinal lining. COX-2 inhibitors are less likely to cause stomach ulcers and bleeding than commonly used drugS such as aspirin and ibuprofen (like Advil or Motrin), whicH suppress both enzymes. Another COX-2 inhibitor, Vioxx from Merck, is expected to get FDA approval soon. But some insurers may not cover these drugs because of their expense. Celebrex costs $2.40 wholesale, vs. 2 cents for generic ibuprofen.
SPONGE ACTION. Enbrel, from Immunex and Wyeth-Ayerst, got the go-ahead in November for rheumatoid arthritis. It works by mimicking a receptor for tumor necrosis factor, or TNF, a protein involved in inflammation. "Enbrel essentially sops up TNF like a sponge," says Dr. Frank Arnett, director of the rheumatology unit at the University of Texas Medical School in Houston.
More TNF antagonists are coming, such as Centocor's Remicade, which is already prescribed to treat the bowel disorder Crohn's disease. Also for rheumatoid arthritis is Hoechst Marion Roussel's Arava, an immunosuppressive that got a green light in September. Arava targets only fast-growing white blood cells involved in inflammation. Similar drugs destroy all rapidly developing cells and can lead to organ failure.
Augmenting pharmaceuticals are new approaches to physical therapy. Many doctors now recommend that patients do special exercises to retain function in their joints, prevent further damage, and help avoid drugs. Through weight and aerobic training, traction, and massage, joints can be realigned so they don't wear unevenly on cartilage. Arthritis sufferers also benefit from hydrotherapy, such as water aerobics, which provides a gravity-defying way to strengthen muscles around joints. Along with new drugs, such approaches can help arthritis sufferers get back to doing everything from popping open a can of soda to driving a car.