At first, the symptoms may look as simple as a case of the flu: stiff, achy joints, tiredness, and a general feeling of malaise. But the signs can also point to something more serious, namely, rheumatoid arthritis. Randomly striking 1 percent of the population—women more frequently than men and the young more often than the elderly—the debilitating inflammatory disease can wreak irreversible havoc on the bones of a 30-year-old within three months. Patients suffer weak muscles and unstable joints that can lose motion and become disfigured—up to 75% of sufferers can become disabled. The most active cases of the disease can cause life-threatening damage to the lining of the lungs, the heart and the blood vessels.

For decades, doctors have contended with a hit-or-miss arsenal of medications for the disease, says rheumatologist Robert L. Rosenberg, M.D. Standard non-steroidal anti-inflammatory drugs, NSAIDS, are effective at treating symptoms but can harm the body, causing stomach ulcers, bleeding and kidney problems. The new Cox 2 specific NSAIDS, Vioxx and Celebrex, provide equal symptom relief with dramatically fewer side effects making ulcers and bleeding rare events. They have become the standard NSAID therapy. Celebrex has become the most widely prescribed new drug in history.

Most patients will require additional therapy, including steroids, to control the disease. Historically, half of them would have to face progressive destructive disease possibly leading to joint replacement surgery. Up until now, according to Dr. Rosenberg, “Doctors have had to take a wait-and-see approach with rheumatoid arthritis, following the course of the disease and handling problems as they arise.”

Not anymore. A promising array of new drugs now have shown the effect of knocking the disease into remission. “They don’t cure the disease—we haven’t reached that point yet,” he says. “But for the first time, we’re dealing with breakthrough treatments that get at the underlying process and retard the progression of the disease.”

One startling new drug, called Enbrel, or etanercept, is a product of recombinant DNA technology. It introduces a biological molecule that blocks inflammation and prevents joint damage. Patients inject themselves with Enbrel twice weekly.

The other drug, called Arava, a once-a-day pill that goes under the generic name, leflunomide, represents a new generation of immunoregulatory agents that blocks an enzyme necessary for the inflammatory response.

The results have been astounding, declares Dr. Rosenberg. Nearly 70 percent of patients who have been prescribed one of the new drugs have responded to the regimen. (All of the patients had already failed the standard therapies.) By themselves, or in combination with one of the traditional drugs, both Enbrel and Arava were found to work better than the old regimen alone. X-rays showed that the drug had stopped the joint damage, halting the pitting and erosion of bones. Patients who’ve been on the therapy for two years have maintained function of affected joints.

The trick, Dr. Rosenberg advises, is to pursue treatment quickly and aggressively. ”We’ve found the earlier patients begin with these powerful drugs, the better they do in the long run.” He has observed that “the new drugs cause fewer side effects than the standard therapies.” His group of seven board-certified rheumatologists located at three suburban Maryland sites (Wheaton, Rockville and Laurel) as well as downtown Washington, D.C. was instrumental in the clinical testing of the new medications. “Because we’re involved in research,” he adds, “we tend to be very experienced with these medications by the time they’re on the market.”

The physicians at Arthritis and Rheumatism Associates, all cited as “Best Docs” by the Washingtonian, continue to look for additional therapies. Dr. Rosenberg reports two other medications for rheumatoid arthritis are in the wings. But he’s thrilled with the promise shown by Enbrel, Arava, Celebrex and Vioxx: “These drugs are nothing short of a revolution in the field of rheumatology.” For more information on rheumatoid arthritis or a physician referral, please call (301) 942-7600 or (202) 293-1470.