Rheumatoid arthritis (RA) belongs to long-term disorders in the autoimmune system and primarily affects the joints. However, the scope of its adverse impact may be wider and reach other body parts (Choy, 2012). Due to being a rather serious disease, RA constantly requires the scientists to come up with new effective treatments for those who suffer from this illness. The current literature review is aimed at evaluating the latest RA treatment methods and their risks and benefits.
Summary, Synthesis, and Assessment of the Sources
The articles by Gabay et al. (2013), Moreland et al. (2012), and Smolen et al. (2013) examine the ways of treatment of RA. Each research paper has a common general subject of investigation, which is RA. However, all of the articles have specific goals, involve different participants, and perform divergent studies to answer their research questions.
The article by Gabay et al. (2013) evaluates the benefits of tocilizumab monotherapy over adalimumab monotherapy in the treatment of RA. The research by Moreland et al. (2012) focuses on oral triple therapy versus etanercept plus methotrexate. Smolen et al. (2013) discuss the recommendations of the European League against Rheumatism (EULAR) for the control of RA with biological and synthetic disease-modifying antirheumatic medicines. Unlike Gabay et al. (2013) and Smolen et al. (2013) who investigate the chronic state of the disease, Moreland et al. (2012) examine treatment methods for the early aggressive RA type.
Gabay et al. (2013) obtained their results due to a randomized double-blind study involving participants from 15 countries in Europe, North and South America, and Australasia. The requirements to patients were age over 18 and intolerance to methotrexate (Gabay et al., 2013). Every 4 weeks, patients received tocilizumab 8 mg per kg body weight (intravenously) plus every 2 weeks, they received placebo subcutaneously; or every 2 weeks, they were prescribed adalimumab 40 mg subcutaneously plus every 4 weeks, they received placebo intravenously (Gabay et al., 2013). The experiment lasted 24 weeks. Patients were differentiated according to the country of origin and the duration of the disease.
Unlike Gabay et al.’s (2013) article, the research by Smolen et al. (2013) does not concentrate on certain kinds of drugs but presents several different recommendations for RA treatment. The scholars separate treatment into three phases and suggest various drugs for each of them. At phase I, depending on the patient’s condition, Smolen et al. (2013) recommend methotrexate, glucocorticoids, leflunomide, and sulfasalazine. At phase II, adding a biologic agent or changing to a second conventional synthetic DMARD is advised. Phase III involves changing the biological treatment or switching to Tofacitinib (Smolen et al., 2013).
Moreland et al. (2012), as well as Smolen et al. (2013), research the impact of treatment with the help of methotrexate. However, they examine its implications along with oral triple therapy versus etanercept. Additionally, Moreland et al.’s (2012) study investigates the treatment methods for a concrete patient category, namely those having early aggressive RA. As well as Gabay et al. (2013), Moreland et al. (2012) performed a randomized double-blind trial. Four varieties of treatment were administered to patients: immediate treatment with MTX plus etanercept, immediate oral triple therapy, step-up from MTX monotherapy, and MTX plus sulfasalazine plus hydroxychloroquine (Moreland et al., 2012).
All the reviewed articles come from reliable journals and are written by reputable scholars and physicians. The sources incorporate a vast amount of research data which is appropriately classified and investigated. The articles suggest valuable material for present and future investigations of the issue of RA treatment methods.
Major Results about Benefits and Risks of Treatments Discussed in the Articles
The advantages of the discussed RA treatments are basically the same: relieving the pain, helping the patients cope with the disease symptoms, and letting them lead a satisfactory lifestyle. The risks presented by the treatment methods vary in accordance with the drugs and methods.
The identified risks of RA treatment by tocilizumab were connected with upper respiratory tract infections, nasopharyngitis, and worsening of RA symptoms (Gabay et al., 2013). Treatment discontinuation was most commonly caused by musculoskeletal and connective tissue disorders and increased liver enzyme concentrations (Gabay et al., 2013).
The limitations of treatments defined by Smolen et al. are autoantibody positivity (rheumatoid factor and/or antibodies to citrullinated proteins), a high disease activity state, and the early presence of joint damage (Smolen et al., 2013).
The risks of Moreland et al.’s (2012) study were concerned with cardiac disorders, respiratory and musculoskeletal systems, lymphatic and immune systems, and other issues. There were several death cases and some serious infections observed.
Conclusion
The reviewed articles suggest various significant approaches to the treatment of one of the most severe diseases – rheumatoid arthritis. As the illness has many modifications, treatment methods also have many varieties. The reviewed research papers are valuable sources of getting acquainted with the modern RA treatment methods and finding out about their advantages and limitations for the patients. The articles come from peer-reviewed journals, which makes them reliable sources of information. The obtained data presents an essential base for the current treatment and further research.
References
Choy, E. (2012). Understanding the dynamics: pathways involved in the pathogenesis of rheumatoid arthritis. Rheumatology, 51(suppl. 5), v3-v11.
Gabay, C., Emery, P., van Vollenhoven, R., Dikranian, A., Alten, R.,… Kavanaugh, A. (2013). Tocilizumab monotherapy versus adalimumab monotherapy for treatment of rheumatoid arthritis (ADACTA): A randomised, double-blind, controlled phase 4 trial. The Lancet, 381(9877), 1541-1550.
Moreland, L. W., O’Dell, J. R., Paulus, H. E., Curtis, J. R., Bathon, J. M., St.Clair, E. W.,… Cofield, S. S. (2012). A randomized comparative effectiveness study of oral triple therapy versus etanercept plus methotrexate in early aggressive rheumatoid arthritis: The treatment of early aggressive rheumatoid arthritis trial. Arthritis and Rheumatism, 64(9), 2824-2835.
Smolen, J. S., Landewé, R., Breedveld, F. C., Buch, M., Burmester, G., Dougados, M.,… van der Heijde, D. (2013). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Annals of Rheumatic Diseases, 0, 1-18.