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Arthritis relief comes at high price

Tue., Sept. 22, 2009, midnight

Rheumatoid arthritis is a devastating disease. Besides crippling joints, it can leave the victim exhausted and in excruciating pain.

During the past several decades, drug companies have offered patients a Faustian deal: prompt pain relief with serious long-term consequences.

In the 1950s, doctors prescribed cortisone-type drugs to reduce inflammation and alleviate pain. These medications were seen as wonder drugs. Patients came into the office on crutches or in wheelchairs. Within a few weeks on drugs like dexamethasone, prednisolone or prednisone, they were walking again.

It took many months or even years before side effects such as cataracts, glaucoma, weight gain, high blood pressure, muscle weakness, ulcers, irregular heart rhythms or diabetes showed up. Osteoporosis is another catastrophic consequence of long-term, high-dose steroid use. We’ll never forget the rheumatologist who told us that corticosteroids “melt bone.”

Many of these arthritis patients felt betrayed when they discovered that their pain relief came at such a high price to their health.

That’s why nonsteroidal anti-inflammatory drugs (NSAIDs) became so popular. The very name implied that they were not as dangerous as “steroids.” Drugs like diclofenac (Voltaren), etodolac (Lodine), flurbiprofen (Ansaid), ibuprofen (Motrin), indomethacin (Indocin), ketoprofen (Orudis), nabumetone (Relafen), naproxen (Naprosyn), piroxicam (Feldene) and sulindac (Clinoril) each had its moment of glory.

The only problem with NSAIDs is that they, too, have some serious side effects. They raise blood pressure, increase the risk for heart attacks and strokes, irritate the digestive tract and can result in bleeding ulcers. Other complications can include visual disturbances, irregular heart rhythms, kidney problems and ringing in the ears. It was estimated that more than 16,000 people died each year as a result of gastrointestinal bleeding triggered by NSAIDs (New England Journal of Medicine, June 17, 1999).

Fast-forward to the late 1990s and the introduction of “biologic medications.” TNF blockers such as adalimumab (Humira), certolizumab (Cimzia), etanercept (Enbrel), golimumab (Simponi) and infliximab (Remicade) were heralded as miracles against rheumatoid arthritis. (TNF stands for tumor necrosis factor, a natural compound produced in the body.)

By affecting the immune system, such drugs were supposed to eliminate inflammation in the joints, slow or reverse the disease process and prevent joint deformities. Many experts described these drugs as revolutionary, fundamentally altering the treatment of rheumatoid arthritis.

It should not be surprising that the TNF blockers turn out to have some serious complications. The Food and Drug Administration has issued new warnings that these drugs can increase the risk of certain cancers (lymphoma and leukemia). People who never had psoriasis may develop this skin problem when they stop the medicine. Because these drugs suppress the immune system, both bacterial and fungal infections may become life-threatening. Liver damage is another rare but very serious reaction.

This history should lead patients and doctors alike to be cautious in looking for the next miracle cure for rheumatoid arthritis.



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