Our practice was involved with the first biologic medication that was ultimately approved for rheumatoid arthritis, called Enbrel (generically called etanercept). Following that effective medication, the second RA drug approved was Remicade, and the third was Humira. All three are tumor necrosis factor (TNF) inhibitors because studies have shown that the inflammation involved in rheumatoid arthritis and other inflammatory rheumatic disease conditions is partly due to the turning on of inflammatory mediators.
In addition to biologic medications prescribed for inflammatory rheumatic diseases, other treatments have been developed. These include several different medications to treat systemic lupus, including Benlysta and Saphnelo. Others are currently in the approval process.
Prior to the development of these medications, providers were limited to recommending steroids, which can be effective, but do have side effects including weight gain and facial and abdominal swelling. In patients with osteoarthritis, nonsteroidal anti-inflammatory drugs may be used, but they can have limited effectiveness in more significant inflammatory conditions such as rheumatoid arthritis. Methotrexate is the principle immune suppressant that is used to treat inflammatory arthritis, and it can be quite effective in some patients, but is generally not as effective as biologic medications including Enbrel, Remicade, Humira, Simponi Aria, Cimzia, and others.
There are new medications on the horizon, and our practice has stayed at the forefront in the development of these new medicines.
For patients with osteoarthritis, we try to recommend surgery as a last resort, but total joint replacement in the hips and knees has improved substantially and is a very good option for patients with bone-on-bone or a complete loss of cartilage in the knees or hips.
We also offer qualifying patients infusions and intramuscular injections of the biologic medications such as TNF inhibitors and other biologics like Actemra and Orencia that can be quite effective for controlling inflammation and potential joint damage. We administer those medications intravenously in the office under careful, professional oversight. Our providers are very experienced in administering these intravenous infusions and/or intramuscular injections with biologic medications.
Kinase inhibitors such as Xeljanz, Rinvoq, and Olumiant have also been approved by the FDA for use in certain patents. Currently, they are considered second-line medicines because of potentially more side effects compared to the biologics, but they can be effective.
We have done research among fibromyalgia patients showing that muscle pressure is about three times higher than in normal controls. In some cases, we recommend muscle relaxants and medicine to help obtain restorative sleep, which often helps to reduce pain.