Dr. David Arbit has great enthusiasm for the medical breakthroughs in the treatment of arthritis. Emphasizing, of course, that it is imperative to have a proper diagnosis, Arbit has high hopes for treating these complex autoimmune disorders.

“There are many new drug therapies for rheumatoid, inflammatory and psoriatic arthritis on the market today that target specific symptoms of the diseases and have fewer side effects than their predecessors. The newer medications, like Humira, Enbrel, Remicade and Retuxan, halt the progression of these diseases, and with early intervention, significant damage to the joints need not occur.” Additional good news is that a vast majority of arthritis sufferers will tolerate the new meds without any significant increased risk of infection.”

Specifically, the newer medications selectively reduce the swelling in and damage to the joints. Because of this selectivity, there are fewer side effects. The older medications suppress the entire immune system, hence the greater likelihood of side effects.

“The difference to the patient is that these newer drugs are easier to tolerate and work very well,” Arbit says. “Before these drugs, patients would experience chronic deterioration of the joints.”

Bear in mind that the newer medications are self injection or intravenous infusion therapies. But, Arbit points out, patients who might have needle phobias get over them when they see how well the drugs work.

Side Effects and Risk of Infection

No drug is perfect, but concerns about significant side effects and vulnerability to infection are reduced. “We don’t really see much increase in infections with these medications,” Arbit says. “The vast majority of arthritis sufferers will tolerate them without any increase risk of infection.

Older drugs like methotrexate, which was originally developed as a cancer drug, don’t just target the joints, they attack the lining of the mouth, hair follicles and the liver. The drug acts by inhibiting the metabolism of folic acid. That is why it is necessary, for example, to take folic acid, which mitigates side effects, to replenish what has been depleted by the therapy. New drugs don’t attack hair follicles, so the folic acid is not necessary

One of the major benefits of the newer drugs is that they work so well, patients can be taken off prednisone, a corticosteroid which reduces swelling, but cause weight gain and increased blood glucose levels.

Which drug for which form of arthritis?

The medications are approved and work equally for both rheumatoid and psoriatic arthritis because they are similar illnesses. The fundamental difference is that with psoriatic, the patient gets a skin rash. Of course, the physician notes, a patient can suffer from psoriatic arthritis even if psoriasis itself does not emerge. “Five to 10 percent of individuals with psoriatic arthritis do not suffer from psoriasis” Arbit says.

The differentiation between the two forms of arthritis comes in the pattern of joint swelling. There are subtle differences between the two. Treatments for rheumatoid and psoriatic are the same so it doesn’t make a difference on some levels.

Despite his endorsement for the newer medications, Arbit indicates that it is customary to begin therapy with oral medications because some patients will respond fully.

“Physicians have the responsibility to try the oral meds to see if they work before moving on to the self injection and IV therapies,” Arbit says. “We don’t start them immediately upon diagnosis, but we move to them fairly swiftly if we don’t see a positive response to the oral meds. It is very important that patients and their doctors treat this illness very seriously – before any permanent damage occurs.”

Arbit feels that the most significant benefit of the newer therapies is two-fold.

“The newer drugs halt the progression of the disease,” Arbit says. “If the treatment is initiated early on, you can prevent permanent damage to the joints.

And finally, and perhaps most importantly, the treatments for rheumatoid, inflammatory and psoriatic arthritis make such a dramatic and positive difference in the quality of life.”

David Arbit, M.D., is chief of the division of rheumatology at The Valley Hospital in Ridgewood, N.J.