New treatments for arthritis

Rheumatoid arthritis (RA) is undergoing a virtual revolution in disease management. Novel treatments are being developed at a fast clip to tackle the hallmark symptom associated with RA - inflammation - as well as the accompanying joint and tissue pain, swelling, redness, burning and stiffness.

If standard therapies don't result in a measurable improvement in the disease, your doctor may consider one of the four new "biologics," or biologic response modifiers now available. As the name implies, these medications are created from living tissue. A piece of DNA taken from one cell nucleus is placed in another. Because the DNA carries genetic information, the combination creates a new biologic agent.

These biologics can selectively alter, remove or decrease the cell chemical, or other element within the body's immune system that destroys joint tissue. In the battle against RA, these new drugs are the new generation of smart weapons.

Three of these new medications - adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) - target a chemical in the body called tumour necrosis factor (TNF). TNF is a master hormone that turns on additional hormones that cause inflammation in RA and many other diseases. Blocking TNF may lessen pain and swelling in the joints, slow the progress of the disease and stop permanent damage.

The fourth biologic, anakinra (Kineret), blocks a chemical called interleukin-1 (IL-1), a natural part of the immune system's attempt to fight off infections. IL-1 acts as a chemical messenger, causing inflammation and tissue damage.

All these medications are similarly effective. Costs of the drugs are also similar, ranging from about $18,000 to $60,000 annually.