This is a wonderful time to be a Rheumatologist. Our understanding of the wide scope of immune mediated inflammatory diseases has increased considerably. The intricacies of how inflammation starts, what causes it to increase in intensity and what suppresses that activity are becoming more clear.
When I began my training, the magic answer for treating Rheumatoid Arthritis was gold shots. The problem with this approach is that it took weekly injections for 5 months to determine if there was going to be a beneficial response. Of the 20% who did get better with this therapy, only 25 % were still on the medication after the first year due to adverse effects.
The current "gold" standard in RA therapy are the biologics. These are a collection of medications that target the actual trigger mechanism of our body's inflammatory response. With these new therapies, the response rate is now 75% in usually less than 12 weeks. Due to the risk of immunosuppression, we must monitor closely for infections, but very few patients discontinue the medications for safety reasons. What is even more significant is that approximately 30% of patients reach a point of clinical remission, the goal of any medical therapy.
We at Jacksonville Center for Clinical Research have played a role in this advancement. We have conducted multiple pivotal studies evaluating not only the efficacy of these medications, but their safety as well. This has given our patients the opportunity to contribute to the process of evaluating these medications, as well as the chance to benefit from these modalities years before they will be available commercially. We are currently enrolling for a study which is evaluating the effectiveness of an oral medication, tofacitinib, with and without methotrexate versus a combination of injectable adalimumab, Humira, and methotrexate.
Our involvement in Rheumatology has not been limited to rheumatoid arthritis. We have also been involved with studies evaluating osteoporosis, gout, systemic lupus erythematosus, and osteoarthritis. We are currently looking for patients to participate in a study to evaluate the safety and clinical improvement of tanezumab in patients with osteoarthritis of the hip or knee. This is a new approach to treatment. Tanezumab binds and inhibits the action of nerve growth factor which hopefully will reduce the pain suffered by these patients.
The goal of research is always to advance our knowledge in regards to these very complicated diseases and to develop new effective and safe treatments. We have come a long way towards that goal in the past 20 years, thanks to the patients that have volunteered to participate in these studies. I see more breakthroughs in the future.