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Rheumatoid Arthritis Webcast

Is Your RA Treatment Working for You?

Medically Reviewed by Ed Zimney, M.D.

Wondering if you're on the right track or need a change in your RA treatment plan? Listen to the latest developments in rheumatoid arthritis treatment and research - and then talk to your doctor about what's right for you.


Now, here’s your host.

Mary White:
Hello and welcome to our program. I’m your host, Mary White.

Tonight, we’re going to be discussing the newest in RA treatments as well as what is on the horizon for RA patients.

Currently, there are over 2 million Americans with rheumatoid arthritis. Now, while the causes of RA are unknown, there are numerous treatment options to help control the disease. Now, to speak with us tonight about these options we have Dr. Scott Zashin. Dr. Zashin is a clinical assistant professor at UT Southwestern in Dallas, Texas and past president of the Lupus Foundation, North Texas chapter.

He’s on the board of the Arthritis Foundation of North Texas. He is board-certified in internal medicine and rheumatology. Dr. Zashin specializes in treating rheumatoid arthritis, systemic lupus, osteoarthritis and fibromyalgia. His expertise and compassion have led to great improvements in his patients’ conditions.

Dr. Zashin is also the author of “Arthritis Without Pain: The Miracle of TNF Blockers.”

Also joining us is Dr. Richard Jimenez. Dr. Jimenez has a long history of clinical research and treatment in rheumatoid arthritis, osteoarthritis, pain management and other conditions. Currently, he works with the Seattle Arthritis Clinic, is medical director for Evergreen Clinical Research Associates and is a clinical associate professor of medicine at the University of Washington.

Current treatments for RA focus on relieving pain, reducing inflammation, preventing joint damage and improving quality of life, and there are many options. It’s important to get an early diagnosis and to work with your rheumatologist and the rest of your healthcare team to find the best treatment program for you.

Dr. Zashin, can you describe the different types of medications that are currently administered? 

Dr. Scott J. Zashin:
There are approximately five different types of medications that we use to treat rheumatoid arthritis. The most common and well-known are the nonsteroidal anti-inflammatory drugs (NSAIDs). Examples include over-the-counter products such as ibuprofen (Advil, Motrin) or naproxen (Aleve). These are prescribed in higher doses with prescriptions. The nonsteroidal anti-inflammatory drugs work fairly quickly in helping patients’ pain and inflammation. They usually will get maximum benefit within two to four weeks.

They do have potential side effects that are fairly well-known, including stomach ulcers and bleeding. They also may affect kidney or liver function. And more recently, we’ve learned that almost all the anti-inflammatories with long-term use may be associated with a slight increased risk for heart attack or stroke.

For patients who have rheumatoid arthritis, we’ll use the nonsteroidals temporarily while we try to find ways to control the disease with what we call DMARDs (disease-modifying anti-rheumatic drugs) or biological DMARDs.

Other medications we may use in the short run include analgesic drugs. For example, acetaminophen (Tylenol) is the most widely known. Sometimes we use narcotic medications to help with pain.

Prednisone (Deltasone, Orasone) has been around for a very long time. And when it was first introduced, it was considered a miracle drug. It still is, but we’ve learned that there are a lot of potential side effects with long-term use of prednisone [and all other corticosteroids]. In the past, many rheumatologists shied away from using prednisone because of the potential downside or risk to the medication, but we’ve learned recently that prednisone, in addition to helping patients feel better quickly, can also help slow down and prevent damage to the joints. So rheumatologists are now taking another look at this type of medication early in the disease.

And then we come to the gold standard treatment for rheumatoid arthritis, the disease-modifying drugs (DMARDs). We use nonsteroidals and prednisone with them because in most cases these disease-modifying drugs may take anywhere from eight to 12 weeks to start working, and we need to have something to use until these disease-modifying drugs can kick in.

Now, the most commonly used one is methotrexate (Rheumatrex). This is what we consider our gold standard treatment. It’s indicated for patients with moderate to severe disease.

In patients who may have mild rheumatoid arthritis, we often can get away with potentially safer medications such as Plaquenil (hydroxychloroquine) and a drug called sulfasalazine (Azulifidine).

If the patient does not respond to the disease-modifying drugs, we have the next class of medications, the biological response modifiers.

Three of these are what are called TNF (tumor necrosis factor) blockers. That means they block a protein in the blood called tumor necrosis factor from being an active protein. By doing so, patients’ inflammation and pain will often go away because TNF causes inflammation. These TNF blockers will also help slow down and prevent damage to the joints. And by preventing damage, we’re decreasing the risk that these patients will become disabled from their rheumatoid arthritis. [Medical editor’s note: The three TNF blockers approved for RA treatment are Enbrel (etanercept), Remicade (infliximab) and Humira (adalimumab).]

What we’ve recognized over the years is that early treatment may make a big difference in terms of the long-term outcome of patients. We recommend early referral to rheumatologists for appropriate diagnosis. And if they do have rheumatoid arthritis, we recommend appropriate treatment so we can attack this condition early and have the best chance of diminishing the damage and disability that can result from rheumatoid arthritis.

Most of these treatments would include a combination of analgesics and maybe prednisone before the other ones kick in? 

Dr. Zashin:
That’s right. Combination therapy may manifest in several ways. It may be nonsteroidal, such as ibuprofen or Celebrex (celecoxib), in combination with methotrexate.

It may be prednisone in combination with methotrexate. It may be analgesic drugs, such as acetaminophen or prednisone and methotrexate.

Or we combine disease-modifying drugs like methotrexate in combination with one of the newer biologic response modifiers, such as the TNF inhibitors mentioned above. Because what we’ve learned is that while patients may do quite well with methotrexate alone and some patients may do quite well with a TNF blocker alone, 70 to 80 percent will need a combination of a TNF blocker with some other disease-modifying anti-rheumatic drug to try to get the beneficial effect we’re seeking in helping people with rheumatoid arthritis.

There’s a small percentage of patients, maybe 20 percent, who can go into remission on methotrexate, and there’s a 20 percent group of patients who can go into remission on the TNF blockers alone, but you’re more likely to go into remission with a combination than either drug alone.

The standard of care for people with moderate to severe rheumatoid arthritis is methotrexate as a first line, and then after eight to 12 weeks most will add a TNF blocker. But if a patient is particularly severe, some rheumatologists will start the TNF blocker shortly after starting methotrexate. They won’t wait 10 to 12 weeks. They’ll be aggressive early. 

Dr. Jimenez, what medications are out there that patients may not know about? 

Dr. Richard Jimenez:
Less than a year ago, two new biologic agents were approved by the FDA to use for rheumatoid arthritis, particularly for the patients with moderate to severe RA who had already had a trial of one of the anti-TNF drugs.

One of these is called abatacept or Orencia. It has a different mechanism of action. The other biologic drugs, the anti-TNF drugs, interfere with one specific cytokine, or chemical mediator of inflammation, being released by the immune system [TNF]. And the difference with abatacept is that it interferes with the communication between the cells, particularly the T-cell line and prevents the activation of T cells [a type of lymphocyte, which in turn is a type of white blood cell]. And if you prevent the activation of these T cells, you prevent a number of different actions, not just inhibiting the production of TNF, but you down-regulate the immune response in general and, hopefully, the autoimmune response. So that would be one of the newest agents being used for people who have had an inadequate response to one of the anti-TNF drugs.

That was released last February. Shortly thereafter, rituximab (Rituxan), which is also a monoclonal antibody, was approved by the FDA to treat rheumatoid arthritis. That’s an agent that has been around since 1998. It was first approved to treat B-cell lymphomas (a type of cancer). B cells are one of the other cell types in our immune system and that are actively involved in autoimmune disease processes and particularly in rheumatoid arthritis.

Rituximab, when infused intravenously, attacks certain B cells. In this case, it actually destroys the B cell and does that very quickly. It has a prolonged effect, usually for six months or longer in terms of its therapeutic effect. So this would be another biologic agent that is new and is being used for those patients with moderate to severe RA that have failed the standard aggressive therapy.

In regard to analgesics, recently, a long-acting once-a-day formulation of an opioid called Opana or oxymorphone has been released. This is a very potent narcotic analgesic that would have a limited use for people who have severe disease and are living with daily pain. This would allow them to take a once-a-day preparation and get pain relief throughout the day. Drug companies are bringing out therapies other than the disease-modifying agents that are aimed at quality-of-life issues.

With something like that, wouldn’t there be a lot of side effects? Could you drive? 

Dr. Jimenez:
People who take opioids on a continuous basis do very well. After three to four days, the brain adjusts to the sedating effects of the opioid while maintaining the analgesic effect. Driving skills tests have been done on patients taking chronic morphine. One looked at taxicab drivers in New York City who were on methadone maintenance programs, and they had fewer accidents than the non-methadone-taking taxicab drivers.

Intermittent use of an opioid is much more dangerous in terms of getting a sedating effect than it is with the use of long-acting agents. One of the changes over the last several years in terms of treating not only arthritis but other nonmalignant pain conditions is the appreciation of the potential benefit of using long-acting agents. Opana is just the newest member of that group.

I would imagine that the cost for some of these treatments could really add up. Are they expensive, especially the biologic drugs, Dr. Jimenez? How do people afford it? 

Dr. Jimenez:
Unfortunately, many people can’t. The average yearly cost for the biologic would be about $18,000, at least in the state of Washington. It does vary somewhat around the country. And if, say, someone responds well to Rituxan but needs the infusions every six months, that could run $30,000.

Some of the cost is clearly justified for the new biologics because the production costs are high. But still, one could argue whether that justifies the $18,000 a year cost.

How can our listeners find out about assistance programs if they are having trouble covering the cost of the medicine? 

Dr. Jimenez:
There are two situations. A person who has no medication coverage can go straight to the company making the drug that they’re trying to receive. If it were Humira, one of the anti-TNF drugs, they would go to Abbott’s Web site and they have a help line. Similarly, Enbrel is made by Amgen, Remicade by Centocor, Orencia by Bristol-Myers Squibb and Rituxan by Genentech. As you can imagine, it is in the company’s best interest to help you get coverage for their drug, so they have extensive resources available.

For people who have some insurance coverage but who have a high co-pay so they can’t forward even their portion of the drug, which often is hundreds of dollars, there are several foundations or funds that they can access, and most – I’m sure all rheumatologists have this information in their office. But, for example, there’s a Chronic Disease Fund, the HealthWell Foundation, Patient Access Network Foundation and Patient Advocate Foundation. All of those foundations do provide co-pay assistance for patients with rheumatoid arthritis to receive any of the biologics.

Talking with the rheumatologist and the billing specialist in the rheumatologist’s office would be the way to find out what an individual person would qualify for.

What kind of RA treatments are on the horizon? What’s in development? 

Dr. Zashin:
Well, there are a lot of new agents on the horizon. The first one is what’s called HuMax-CD20 (ofatumumab), and that is similar to rituximab, but it’s fully humanized. The advantage of that is that patients are less likely to develop an allergic reaction.

Another one that I think may be quite exciting is a drug that blocks a protein called interleukin-6. Now interleukin is what’s called a cytokine, and tumor necrosis factor is one particular cytokine. What a cytokine is, is it’s a messenger between cells. It provides a signal.

Interleukin-6 has been demonstrated to be involved in the inflammation in the lining of the joint. So what this drug is being developed to do is to block interleukin-6, again using a monoclonal antibody, like Dr. Jimenez described, and by blocking this protein there’s evidence that patients have done quite well. And in fact – the studies are small, but there’s no evidence at this time that they increase the risk for infection.

So, again, we’re looking for not only drugs that are effective but also drugs that are safe. And that’s really the goal of treatment. The ideal drug is one that helps people but doesn’t cause additional problems.

Some people are looking at a TNF blocker that may be taken orally, by pill, instead of requiring the injections that we now need to do.

How should you approach your doctor about these new drugs? 

Dr. Jimenez:
Any discussion of waiting for future treatments has to be in the context of disease activity now. Because over the last five years, since the advent of the anti-TNF agents, we’ve learned that modifying the disease early has a better long-term outcome, not only for the disease but for the other co-morbidities, such as cardiovascular disease risk.

So when people approach the topic with me, it’s easy to say what else is out there, but I think the discussion should focus with what treatments are available now and the risk/benefits of the different ones.

We have a lot of e-mail questions. Becky in Anacortes, Washington asks, “How do you know if the progression has stopped? I take Enbrel (etanercept) and methotrexate and was taking Plaquenil (hydroxychloroquine). I still have a lot of pain some days, and my feet feel burning sometimes. Does this mean they aren’t working?”

Dr. Zashin:
We use a number of things to help us determine if the arthritis is progressing or not. The first thing we do is to measure something. What I do in my practice is perform what is called a DAS score (Disease Activity Score), DAS 28, which is a composite of four pieces of information: how the patient is doing overall; the number of tender joints the patient has, determined by the physical exam; the number of swollen joints; and a blood test called a sedimentation rate.

I put all that information into a calculator which gives me a number. Based on that number, I can tell if the patients have a severe disease, if they’re in remission or if they’re in between. I try to record a number each time I see the patient, and that helps me become a little more objective about whether the patient’s symptoms are progressing or not.

Some doctors won’t use a DAS score. They may use other scoring systems, or they may just go with their own clinical impression.

We also use X-rays, typically of the hands and feet, to look for any changes on X-rays. One of the changes we will typically see with rheumatoid arthritis is that the space in between the joints or cartilage narrows, or patients may develop little holes in the bone, what we call erosions. So we can look at X-rays from year to year to see if there is any change or progression.

So these are the typical ways that a rheumatologist will help determine if there’s progression. Now, just because your rheumatoid arthritis is not progressing, in fact your rheumatoid arthritis could be in remission, you still may have some of the symptoms that the caller has mentioned. For example, burning is one of the symptoms they mentioned or pain from time to time.

Many patients with rheumatoid arthritis will have another condition that they develop associated with this called fibromyalgia. And fibromyalgia is probably the most common condition rheumatologists see. It’s characterized by widespread body pain, fatigue, and many patients complain of not feeling rested in the morning. So a patient’s rheumatoid arthritis may be completely controlled, but they may have fibromyalgia, and that may be causing their symptoms, as opposed to rheumatoid arthritis.

The treatment for that is to get better and more sleep. Sometimes we do sleep studies to rule out sleep apnea. Exercise is very important in the management of fibromyalgia, so we encourage aerobic exercise.

And, finally, burning in the feet can be related to another condition called neuropathy. Some patients may get inflammation of nerves called neuropathy or pain that is related to the nerves, and that may be treated in a different fashion.

So, to summarize, rheumatologists have certain ways to determine if there is progression. And if the rheumatologist suspects the rheumatoid arthritis is stable, they may want to look into other causes for the symptoms.

We have a question from Deborah in Houston, Texas. Her question is, “Do you feel the evidence is clear that the new biologic drugs do not increase the risk of malignancy above what is normally expected in the RA population? Is there any explanation as to why RA patients have an increased risk of certain cancers such as lymphoma?” 

Dr. Jimenez:
Well, first, I do not feel that the evidence is clear.

And I feel that most rheumatologists would agree that we cannot say we know enough and have followed enough people long enough to say that the evidence is clear.

Part of the problem is that there is, at least with lymphomas, an increase in the baseline rate of lymphoma in the rheumatoid population above that of the population at large. Some studies suggest that this is related to disease activity. The assumption is that if people have an altered immune system, it’s not too out of line to expect that there may be a spillover of dysfunction. So your immune surveillance against malignancy might also be impaired while you’re having an autoimmune reaction.

The other aspect, specifically, for lymphomas is that chronic immune stimulation can trigger aberrant growth and flip the switch from this continuous immune stimulation. And what would suggest that would be the studies that show that the most active patients, the people with the most synovitis and the most severe disease, seem to be the ones with the highest risk of lymphoma compared to those with mild disease. And if this proves out, we may even see a lowering of the risk of lymphoma in the rheumatoid population with our treatments over years, instead of an increased risk.

But right now, I would say that I don’t think the evidence is clear.

We have a phone question from Maria in Gulfport, Florida. Maria, go ahead.

Someone recently described to me a process that they undertook called medical holiday. I’ve got mixed connective tissue disease. I was hospitalized in 1997 with dermatomyocytis, but it seems to have resolved into what looks mostly like RA. And I’ve been treated for RA for many years. But I’m on a myriad number of drugs, including Humira (adalimumab) and methotrexate (Trexall, Rheumatrex). And I take prednisone (Deltasone, Orasone) and Plaquenil (hydroxychloroquine), and I’m still symptomatic. I can walk and such, but I’m symptomatic.

My doctor recently said it’s very difficult to what she’s dealing with because she feels that a lot of my symptoms are being masked by all these meds. And a medical holiday, theoretically, is where you stop taking medications so that you can unmask symptoms and diagnose more properly. Not to mention, I’m sick and tired of taking all these meds and their side effects – especially prednisone. So I wonder if you’ve heard of this and if it works and how it’s done, etc.

Dr. Zashin:
Well, first of all, with any person on chronic medication the goal is to limit their medication to what they really need. So in your situation if I were seeing you as a new patient, and I would want to try to get a better understanding of what’s going on, I think the first medication I would try to decrease or get you off of would be the prednisone. And I would probably do it on a very gradual basis. And I think you’re probably more likely to have a flare-up as you taper the prednisone.

Some people may elect to try to decrease the methotrexate or consider stopping Plaquenil. I probably wouldn’t call it a medical holiday. We typically think of medical holidays as, for example, with osteoporosis, some people recommend giving patients a medical holiday from taking drugs like Fosamax (alendronate sodium) or Actonel (risedronate sodium tablets) for a year, for different reasons.

But in your situation, I would say try to see if you really need to take all the medications, especially if it’s a new doctor (for you) and she’s not sure of what is going on with you. Now, you don’t want to do anything too drastic because if you do taper off medications, you have an increased risk of having a flare-up. But because prednisone can work quickly if there’s any suspicion of active disease, that drug could be initiated quicker. What did your doctor suggest? 

She started me on Plaquenil. I hadn’t been on it for quite a while, and she added that to the list of meds. I heard about medical holiday after having last seen her, so I plan to bring this up with her when I see her next.

Dr. Zashin:
That sounds like a reasonable choice. We know Plaquenil overall has a pretty good safety record. And so maybe she’s saying try Plaquenil, and maybe in four to six months once the Plaquenil kicks in she’ll get you off some of the other medications.

I also tried Remicade (infliximab), and I had a very severe reaction to it. Is there something that I might take instead of the Humira because it seems to me that it’s failing? 

Dr. Zashin:
That’s something that you and your doctor are going to have to decide if it’s really failing or not. Again, there may be other reasons why you’re having symptoms not necessarily related to rheumatoid arthritis. And these other new medications have not been out very long to treat rheumatoid arthritis, so we have less information on the long-term benefit/risk.

Dr. Jimenez:
In treating rheumatoid arthritis, we look for evidence of inflammatory disease activity. So that would be the first thing to establish. Do you have active inflammation? Are your X-rays changing? What is your sedimentation rate [a blood test used for screening RA]? How many swollen joints? And then one looks at a risk/benefit of just going on a holiday and taking people off of all of pain medicines to reset the thermostat so that they can then go on to a lower dose of medicine and get control better again.

But in the inflammatory autoimmune realm, the risk of going off all medications is having a significant flare-up that would not easily come under control. I remember 20-some years ago in the days of gold therapy. People would do well, and you would stop the gold, and they would flare, and you almost never achieved the response that you did the first time around.

My personal experience with the anti-TNF drugs, the Enbrel and the Humira, is that people who have to go off of them for an extended period of time – for four, five, six months – often just don’t do as well on the same agent going back on it. So there is a risk in going off completely as opposed to weaning one medicine and adjusting medicines to minimize side effects but not removing all medicines. There’s also a risk of stopping Remicade and then restarting it due to the possibility of an allergic reaction.

The one problem with the newer agents that I talked about earlier, the Orencia (abatacept) and the rituximab (Rituxan) is we don’t have the long-term data that we do with the anti-TNF drugs, both in terms of their effectiveness in preventing X-ray progression and even their long-term side effects.

So I think before giving up the Humira I would really assess what level of disease activity you have and how is it doing at controlling the inflammatory disease and then making sure some of your symptoms aren’t drug side effect symptoms or fibromyalgia or neuropathy or something else that your Humira just won’t treat anyway.

We now have a question from a completely different end of the spectrum. This is from Jackie in Fairfield, Alabama, and the question is, "My RA is only visible in a few of my fingers. Should I get a diagnosis? I've never been diagnosed." 

Dr. Zashin:
Yes. If you have joint symptoms that have persisted for months, I would recommend you see a rheumatologist. It may not be rheumatoid arthritis. There's another type of arthritis called psoriatic arthritis that often affects just a few joints and is often associated with the skin rash of psoriasis. So anybody who has persistent joint symptoms definitely should be seen ideally by a rheumatologist or at least a primary care physician. It’s also possible that what you have is osteoarthritis and not rheumatoid arthritis.

We have another question from Maryanne in St. Claire, Michigan. The question is, "How do I go about volunteering for experimental studies? I have had rheumatoid arthritis for 35 years and am now 55. Am I too old for studies?" 

Dr. Jimenez:
Age is a factor for some studies, but it varies with the study. Most rheumatoid arthritis related studies go up to at least 65, many of them to 75. If she is not connected with a rheumatologist there is a government Web site called clinicaltrials.gov, where all active clinical trials are listed. It's a very easy menu to go through according to disease and then location. A person can find out what clinical trials related to their disease are being done near them, as well as contact information.

We also have a question on research from Carmichael, California. The question is, "Are the pulmonary complications of RA responding to TNF (tumor necrosis factor) inhibitors, and are they having success in preventing them from recurring? How much study has been done in this area?"

Dr. Zashin:

That's an interesting question. We tend to think that anything that controls the rheumatoid arthritis will help the pulmonary complications. The most common one is called pulmonary fibrosis or scarring of the lungs. I haven't seen any definite studies with the TNF blockers in terms of their effect on scarring of the lungs. I also have not seen anything that they aggravate the problem.

Dr. Jimenez:
I know that there is a collaborative study being done because the pulmonary department at University of Washington is participating. I have not seen any preliminary results or had a discussion as to how it is going. And I've not seen anything in the literature. So I would agree that we don't know. But I do know it is being looked at.

I've had patients develop pulmonary fibrosis while on anti TNF therapy – not many, but I have had a few. So my initial impression is no, they don't stop this manifestation of the disease.

Dr. Zashin:
I don't have too many patients who have that complication, so I can't really comment. But for those who are on it, I can't say that it's made a tremendous difference in this condition.

Now, possibly treating these patients earlier – before their arthritis gets bad – may have a beneficial effect. Once the arthritis sets in, the die may be cast in terms of potential problems in the lungs. But I think we'll just have to wait and see what the studies show.

We have a related question from Gordon, Texas. The question is, "I've read that people with RA have a shorter life span than the general population. I have RA and would like to know what I can do to live a normal life span." 

Dr. Jimenez:
Certainly, treating the disease is very important. The role of inflammation as a risk factor for cardiovascular disease has become clear over the last half a dozen years. Cardiologists, as part of their standard evaluation, now check the CRP [C-reactive protein is a blood test which indicates inflammation and is a marker for some diseases], which is an inflammatory marker that we've been checking for 20 years.

Part of the shorter life span is from increased cardiovascular disease, so modifying other risk factors – not smoking, not gaining weight, making sure the blood pressure is controlled, cholesterol is controlled –these are things that any patient can do to change the outcome. Part of the outcome data comes from the '70s and the '80s before we had anti TNF therapy. So part of the reason for the shortened life expectancy is that we didn't control the disease well. People became disabled, they weren't able to exercise; they gained weight and developed all of the complications of being chronically ill.

Now that we're treating the disease better hopefully people will be able to be more active, manage those other co morbidities, and we'll be able to change the statistics on life span.

We have a question from Cheyenne, Wyoming. "I was diagnosed with RA in 2001. In that time, I have been treated with Remicade (infliximab), Enbrel (etanercept) and Humira (adalimumab). Why does the efficacy of these medicines change after about two years of use? Are our bodies suddenly rejecting them, and will this continue to be a problem with the new medicines on the horizon?"

Dr. Zashin:
In general, most people who started TNF blocker – if they get benefit – seem to be able to maintain that benefit. But there are a percentage of people for whom, over time, the TNF blocker loses efficacy. In some of the drugs, such as infliximab or Remicade, part of the reason is that the body develops HACAs (human anti-chimeric antibodies), certain antibodies that block the efficacy of the product.

So it's not uncommon for rheumatologists who prescribe Remicade to gradually increase the dose to try to get a better response.

I would tell the caller that if they're not taking a TNF blocker with methotrexate, that they consider doing so because the combination of methotrexate plus the TNF blocker will improve efficacy in numerous patients.

We have one final question from Crystal in Moultrie, Georgia. The question is, "How long before the newer biologic and TNF meds are available in generic form so those of us who would like to try them can afford to?" 

Dr. Jimenez:
I don't have a specific knowledge of when that is going to happen. But I do know that the argument that is going on right now is what is going to be required of a generic maker to make any generic biologic. Since these are antibody based combination protein molecules, the technology for making the molecule is as important as the end result, the molecule itself.

And how the process is copied, reproduced and measured is a little bit different than making a different tablet with the same chemical. The FDA hasn't figured out whether even to allow biologics as generics or  how to regulate them compared to standard generic medication.

Dr. Zashin, are there any final thoughts you'd like to leave us with tonight? 

Dr. Zashin:
If you or someone you know has joint pain or swollen joints get that checked out, don’t wait. If you do have rheumatoid arthritis, early diagnosis and treatment may help prevent damage, deformity and disability to the joints.

And keep in touch because we're learning more and more about these medications. Check with your doctor each time you come to see them to see if they've learned anything new about any side effects or things that patients should be aware about.

Dr. Jimenez? 

Dr. Jimenez:
I would echo what Dr. Zashin just said and add that if you're hurting, don't just say, "I must be getting older." So many people delay getting evaluations and treatments because they say this is part of getting older. I've had 20 year olds say that. Persistent joint pain with swelling should be evaluated.

I want to thank you both for being with us tonight. And, of course, thank all of you for listening at home.

From HealthTalk, I'm Mary White. Have a great evening.

Last Updated: 01/11/2007