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Conventional Medical Treatments and PEMF Therapy for Rheumatoid Arthritis

 

 

Conventional Medical Treatments

Significant progress has been made in recent years for the relief and control of rheumatoid arthritis. Research has shown that treatment with antirheumatic drugs during the first 3 to 6 months of the disease increases the chances of prolonged remission. The treatment goals are as follows: relieve symptoms, attempt to induce and maintain disease remission, restore or maintain proper joint function, prevent disability, and disease damage to other organs.

Two types of medications are commonly used for the treatment of rheumatoid arthritis: relief medications (nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids) and disease-modifying treatments. The latter aims to control symptoms over a long period. They include traditional treatments (such as immunosuppressants) and biologic response modifiers.

Relief Medications

Anti-inflammatory drugs reduce joint pain and stiffness. They do not slow down the progression of the disease or prevent potential joint deformities. They are mainly used early in the disease, and then intermittently, in case of pain. It is recommended to use them in combination with a disease-modifying treatment to slow down the progression of the disease. Conventional Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Ibuprofen (Advil®, Motrin®), naproxen (Anaprox®, Naxen®), and other anti-inflammatories are useful for relieving symptoms. Aspirin (ASA, acetylsalicylic acid) is rarely used because it is less well tolerated by the digestive system. Regular use of conventional nonsteroidal anti-inflammatory drugs can be associated with gastrointestinal disorders, such as stomach burns, ulcers, or sometimes severe digestive bleeding, as well as other side effects such as hypertension or kidney failure. They are therefore used for the shortest possible period, only as needed. They are sometimes associated with a medication aimed at protecting the stomach, such as omeprazole (Mopral®), or misoprostol (Cytotec®).

Selective COX-2 inhibitors (or coxibs) appeared on the market in 1999. They have the same effects as conventional anti-inflammatories with the advantage of being less irritating to the stomach. Celecoxib (Celebrex®) is one of them. Meloxicam (Mobicox®), which is less selective, can also be used. The use of coxibs is generally reserved for people at high risk of gastrointestinal complications and low risk of cardiovascular diseases. However, these medications do not completely eliminate the risk of gastrointestinal symptoms and should be used with the same moderation as other anti-inflammatories. In September 2004, a medication from the coxib family, Vioxx® (rofecoxib), was withdrawn from the global market because it was associated with an increased risk of heart attacks and strokes.

Acetaminophen or morphine derivatives are sometimes used to reduce pain when it is severe. Acetaminophen (Tylenol) is an analgesic but has no anti-inflammatory effect. Opioids are used for their analgesic effect but quickly induce dependence. Corticosteroids (cortisone, prednisone, prednisolone) are very effective medications for reducing inflammation and relieving joint pain and stiffness. These medications are taken in tablet form or injected directly into the joints. They are often prescribed early in the disease, but their long-term use is limited by side effects, increased risk of osteoporosis, high blood pressure, and infections. Corticosteroid injections or infiltrations are very effective in case of crisis, especially if the number of affected joints is not too high. However, they should not be abused because repeated corticosteroid injections into the joints can lead to the same side effects as when taken orally. Doctors limit themselves to 3 or 4 infiltrations per joint per year.

Disease-Modifying Antirheumatic Drugs: Conventional Agents (csDMARDs)

Antirheumatic medications act directly on the disease by combating the immune cells that attack the joints. This gives them the ability to prevent or delay joint damage. These medications (many of which are immunosuppressants) are even more beneficial when taken early in the disease. They become fully effective after a few weeks to a few months. They can be safely combined with NSAIDs or corticosteroids, which have a more immediate effect.

In this category of medications, methotrexate (MTX) 25 to 30 mg per week for 8 weeks is the most commonly used, in the form of tablets or subcutaneous injections. People taking this medication are recommended to consume folic acid supplements, which help reduce its side effects. Patients with mild disease activity may not need to take MTX, and in case of intolerance, within 6 weeks or less, or contraindication (renal, hepatic, or pulmonary disease), MTX is replaced by sulfasalazine (Salazopyrin) 3 to 4 g per day or leflunomide (Arava) 20 mg per day.

Other antirheumatic drugs used include hydroxychloroquine (Plaquenil) administered alone or preferably in combination with MTX, and can be used in the presence of low disease activity. The effectiveness of csDMARDs in combination with MTX is controversial, and this choice should be discussed between the patient and their doctor. Triple therapy MTX-Sulfasalazine-Hydrochloroquine is now a recognized therapy. As for gold salts (Myochrysine) and azathioprine (Imuran), they are becoming less and less used. Each of these medications has specific side effects.

Biologic Response Modifiers (bDMARDs)

In recent years, a new class of medications has appeared on the market. They are known as biologic response modifiers or biologics (bDMARDs). Unlike other conventional antirheumatic medications (csDMARDs), which fight the action of the immune system in a nonspecific manner, these new therapies are designed to more precisely target the substances believed to be directly responsible for inflammation and joint destruction.

Several types of biologics are available, among which anti-TNF (Tumor Necrosis Factor) agents are the most commonly used. There are now 5 agents blocking the anti-TNF factor or anti-TNF (Tissue Necrosis Factor) factor: infliximab (Remicade), etanercept (Enbrel), adalimumab (Humira), certolizumab (Cimzia), and golimumab (Simponi). Failure of one anti-TNF factor blocker does not contraindicate trying another anti-TNF factor blocker.

In Canada, biologics that counteract the effect of interleukin-1 (anakinra, Kineret) or interleukin-6 (tocilizumab, Actemra), 2 substances that contribute to inflammation together with tumor necrosis factor (TNF), are also approved, as well as 2 other biologics with different mechanisms of action, rituximab (Rituxan), a monoclonal antibody against B cells, and abatacept (Orencia), a blocker of T cell enzymatic stimulation. These medications are all administered by injection, some intravenously and others subcutaneously. In addition to their mechanisms of action, these medications differ in their frequency of administration and some specific side effects. Due to their very high cost and potential for serious side effects, these medications are reserved for people with severe rheumatoid arthritis for whom conventional antirheumatic medications are insufficient. Among the possible side effects of these medications, a reduction in immune defenses against certain infections is particularly noted. For all practical purposes, the use of biologic treatment (bDMARD) provides little better effect than conventional treatments (csDMARD) and does not justify their high cost.

Therapeutic adjustment should be made in relation to the progression or not of joint damage, the safety of treatment, and associated health problems. Consult your doctor or pharmacist for more information.

Reference: New Rheumatoid Arthritis Guidelines: A Quick and Easy Guide published on March 5, 2014

 

PEMF Therapy for Rheumatoid Arthritis: An Anti-inflammatory Therapy

On May 12, 2015, Medscape interviewed Dr. Kevin Tracy of New York. Two neurosurgeons, Drs. Bret Stetka, MD and Kevin Tracey, MD conducted a study titled "Using Electricity to Treat Arthritis and Cancer". This study was undertaken to better understand the relationship between our nervous system and the immune system. The study involved stimulating the vagus nerve using the implantation of a neurostimulator designed to treat epileptic patients. Stimulation of the vagus nerve (by implanting a neurostimulator) inhibits the production of Tumor Necrosis Factor (TNF) by the immune system. The nerve signal via the vagus nerve acts at the spleen where the nerve signal is converted into a chemical signal via T cells that release acetylcholine which in turn inhibits macrophages that produce TNF.

 

Concept of Bioelectrical Medicine: Better targeting therapeutic effect. Better understanding interactions between our nervous and immune systems. Neuronal activity can neutralize inflammatory response. Bioelectrical medicine helps avoid many side effects of medications attributable to off-target activities or related to the production of toxic metabolites produced during clearance mechanisms. Bioelectrical medicine may replace some medications or be used in complementarity. Healthcare professionals will have the opportunity to offer a non-toxic, safer, and more effective treatment.

 

http://www.medscape.com/viewarticle/844247

 

Editor’s Note: As researchers gain a better understanding of the interactions between our nervous and immune systems, bioelectrical medicine is increasingly looking promising in treating numerous conditions, from pain to diabetes to possibly even cancer. Medscape recently spoke with Kevin Tracey, MD, President, the Feinstein Institute for Medical Research at the North Shore-LIJ Health System, Manhasset, New York, about the potential of electricity-based therapy.

Text written by: Jean Charlebois, MD on October 29, 2015