New treatments put rheumatoid arthritis in remission

John Hardin reflects on the 525-mile scenic bike ride he took along the West Coast with Tracie Seimon and her husband in October. They started in San Francisco, headed south to Los Angeles and rode eight hours a day for eight straight days.

Not exactly what he pictured when Hardin met Seimon two years ago. She was 37 and turned to Hardin, a prominent rheumatologist in New York, for help. Other physicians had not been able to diagnose the cause behind a crippling pain that started in her feet, spread to other joints and was accompanied by swelling, fatigue and fever.

"When I see patients in that condition, I am concerned they might end up in a wheelchair,'' says Hardin, vice president of research for the Arthritis Foundation. "She was having trouble walking and needed assistance going upstairs. People don't need to suffer like that anymore."

After examining her health history and running tests, he diagnosed rheumatoid arthritis and put her on an aggressive new drug therapy. The therapy took several months to start working, but she's currently in remission from an inflammatory disease that affects 1.5 million people in the USA and can eventually cause loss of function. It is an autoimmune disease, which means the immune system mistakenly attacks tissues. It can also attack the heart and lungs.

"I am so grateful,'' says Seimon, who lives in Nyack, N.Y., with husband Anton Seimon and their two dogs. "The drugs made me a little nauseous at first, but my body has gotten used to them, and I seem to be tolerating them well now."

She's back doing the field work she loves. A conservation researcher at the Bronx Zoo, she travels to remote destinations in search of pathogens that kill wildlife.

"I have to be strong to do my job,'' she says. "I am often working at high altitudes and flipping over big rocks looking for amphibians." She's looking forward to upcoming field work in Russia, Peru and Vietnam.

The drug regimen she's on includes Enbrel and Methotrexate, which both work on the immune system by blocking or reducing the proteins contributing to the disease process. Plaquenil was developed to treat malaria, Hardin says, but it is also effective in treating early RA.

People who begin treatment within two years of the disease appearing can expect to have low or moderate disease activity with the new treatments, rather than merely relief from symptoms, says Hardin. In a study of 682 people with RA, more than 75% of those treated with Enbrel and Methotrexate experienced no progression of joint damage after three years. The therapies are delivered by injection or infusions.

More new therapies are in the pipeline. The Food and Drug Administration recently approved Tofacitinib, a new class of oral drugs for people with moderate to severe rheumatoid arthritis who haven't been helped by the other therapies. Tofacitinib works by suppressing the immune system, according to the National Institutes of Health.

Not all drugs have been successful; last week, Eli Lilly said it stopped a late-stage trial of the experimental drug Tabalumab because an interim analysis showed it was not working. Lilly said the move was not based on safety concerns; two other late-stage trials of the drug, seen as an alternative for patients who were not helped by Methotrexate, are continuing, as are other smaller studies.

Seimon must remain vigilant to protect herself from getting sick, since her immune system is depressed by the treatments.

"I'm always washing my hands and doing everything I can to make sure I don't get sick in the first place,'' she says. "I'm careful about what I eat and make sure I get enough sleep."

She had one flare-up when she experimented with tapering off the drugs before the October bike ride, but resuming the therapy eliminated the problem. She plans to take them for the long haul. The long-term effect of the drugs is unknown.

"But my choices weren't good ones,'' she says. "Looking at what the alternatives would be, I'd have no life and I wouldn't be doing my research that I love to do on frogs."

USA Today