I am looking at treatment options for rheumatoid arthritis and was wondering if you could give me more information on Arava?

Arava, whose generic name is Leflunomide, is used in treating rheumatoid arthritis. Arava works to reduce the swelling, inflammation, stiffness, and pain associated with rheumatoid arthritis. Arava is also a DMARD or disease-modifying anti-rheumatoid drug in that it protects the patient from future joint damage associated with rheumatoid arthritis. Arava is a dual-purpose rheumatoid arthritis drug; Arava will both relieve patient symptoms and protect against future joint damage invariably seen in rheumatoid arthritis. Currently, Arava is the only oral DMARD for rheumatoid arthritis that is indicated for improvement of physical function.

An important to note with Arava is that you should not take Arava if you are pregnant. In fact, a prescribing doctor should make sure that the patient is not currently pregnant and on a reliable type of contraceptive before having a rheumatoid arthritis patient start Arava. Arava may cause some potential damage to the liver so a doctor should monitor patients with rheumatoid arthritis using Arava with regular liver function tests.

Arava is produced by Sanofi-aventis, a leading global pharmaceutical company. Sanofi-aventis is involved in a variety of drug initiatives in oncology, internal medicine, cardiology, vaccinations, metabolic disease, and central nervous system disorders.

What is rheumatoid arthritis?

Rheumatoid arthritis is a chronic and inflammatory disease process which affects many joints, organs, and tissues in the body. Rheumatoid arthritis or RA mainly will attack joints resulting in inflammation and synovitis progressing to cartilage damage and ankylosis in the joints. In terms of organ damage, rheumatoid arthritis can produce inflammation (diffuse) in the patient’s lungs, pleura, pericardium, and sclera as well as nodular lesions in the skin’s subcutaneous cells.

While the exact cause of rheumatoid arthritis remains unknown, it has been shown that autoimmunity has an pivotal and essential role in how rheumatoid arthritis progresses and remains chronic. A fuller understanding of the disease process and progression of rheumatoid arthritis is increasing the treatment and management options for those afflicted with and suffering from this sometimes debilitating disease.

What are the symptoms of rheumatoid arthritis?

Rheumatoid arthritis of the joints can be summed up as synovitis which is inflammation membrane that lines the tendons and joints known as the synovial membrane. As the joints’ inflammation progresses in rheumatoid arthritis, joints become stiff, tender, and swollen in many different joints. The most commonly affected joints with rheumatoid arthritis are the smaller joints in the hands, feet, and spine but sometimes the larger joints such as the knee and shoulder can be affected. In the early stages of rheumatoid arthritis, gentle movement of the joints may relieve the symptoms and pain.

In rheumatoid arthritis, skin symptoms include most prominently the rheumatoid nodule. Within the nodule of rheumatoid arthritis, there is a central area of necrosis which includes fibrin-rich material. As in most instances of inflammation, a layer of fibroblasts and macrophages surround the central area of necrosis. Sometimes, but rarely, the rheumatoid nodule can occur within some internal organs as opposed to subcutaneous skin.

Rheumatoid arthritis will also affect many other body parts and organs. The hands will undergo inflammatory activity which leads to tethering of the tendons and eroding and destroying of the joints. In rheumatoid arthritis, hand damage will lead to movement impairment and deformity. Fibrosis may occur in many organs such as the kidneys and lungs in rheumatoid arthritis. In the heart and blood vessels, people with rheumatoid arthritis are more prone and susceptible to atherosclerosis and heart attacks.

In about 15% to 25% of rheumatoid arthritis cases, there is anemia present in the patient. As a chronic disease, rheumatoid usually goes through a course of persistent symptoms which come and go (known as waxing and waning). Also, as part of its chronicity, rheumatoid arthritis symptoms will slowly but surely progress to deterioration and destruction of the structures of the joints and result in joint disability and deformations.

Who is prone to or at risk of rheumatoid arthritis?

Currently, around 1% of the population of the world suffers from rheumatoid arthritis. Men, in general, are three times less likely to be afflicted with rheumatoid arthritis; women are three times more likely to develop rheumatoid arthritis than men. Usually the onset of rheumatoid arthritis is between the ages of 40 and 50 although rheumatoid arthritis has been shown to affect persons of any age. Smokers are four times more likely to be affected by rheumatoid arthritis than non-smokers. Some ethnic groups show a much higher prevalence such as some Native American groups which exhibit rates of about 5-6% while some peoples indigenous to some Caribbean regions have much lower than global prevalence rates for rheumatoid arthritis.

Studies have shown that first-degree relatives of rheumatoid arthritis suffers show a prevalence rate of 2-3% (as opposed to about 1% for the general public), and monozygotic twins have a concordance rate of about 15-20%. These statistics suggest a strong genetic component or predisposition to developing rheumatoid arthritis, making family history an important risk factor. Some studies have shown that this inheritance is strongly associated with MHC HLA-DR4 (major histocompatibility complex type HLA-DR4).

What is the differential diagnosis for rheumatoid arthritis as in what other diseases or processes may cause similar signs and symptoms?

There are many other conditions and diseases which may produce or result in symptoms similar to those of rheumatoid arthritis:

• gout or other crystalline induced arthritis
• osteoarthritis
• SLE systemic lupus erythematosus
• psoriatic arthritis
• Lyme disease causing erosive arthritis
• reactive arthritis
• ankylosing spondylitis
• sarcoidosis
• amyloidosis
• Whipple’s disease
• hemochromatosis
• acute rheumatic fever

Although many of these conditions will result in symptoms mimicking rheumatoid arthritis, they may be distinguished from rheumatoid arthritis using x-ray imaging, specific blood tests, and clinical symptoms.

How is rheumatoid arthritis diagnosed?

Rheumatoid arthritis is diagnosed on the basis of clinical symptoms, patient history, x-ray imaging, MRI images, ultrasound imaging, and some specific blood tests including immunological studies for rheumatoid factor or RF and others.

What is the treatment for rheumatoid arthritis?

Currently there is no cure for rheumatoid arthritis, and treatment is aimed at modifying the RA disease process or at alleviating patient symptoms. In many cases, doctors recognize the dual goal of treatment and acknowledge that painkillers will work toward alleviating pain and symptoms but will not prevent damage caused by rheumatoid arthritis. In addition to painkillers, doctors will recommend a simultaneous anti-rheumatic medication (disease modifying anti-rheumatic drug or DMARD) in the treatment of rheumatoid arthritis. Other useful treatments include some light physical activity, weight loss, ice/compression/elevation, and rest.

In the past with rheumatoid arthritis, DMARDs or disease modifying anti-rheumatic drugs were used along with anti-inflammatory once there was evidence of long-term damage occurring in patient joints. These days, DMARDs are used before damage occurs in order to slow the progression of rheumatoid arthritis and to prevent joint damage. Delaying the use of DMARDs have usually resulted in a poorer long-term prognosis and outcome. Studies have shown that ultrasounds and magnetic resonance imaging to be more effective in demonstrating joint damage than the more often used x-ray imaging.

Anti-inflammatory drugs such as glucocorticoids and NSAIDs (non-steroidal anti-inflammatory drugs) and analgesics for painkillers (such as acetaminophen, tylenol, opiates, topical lidocaine) are used for relief of pain and rheumatoid arthritis symptoms. Many patients also report positive symptom relief with some light physical activity, icing, compression, elevating of limbs, weight loss, and rest.

How do I choose the best treatment for rheumatoid arthritis?

Since there are so many different treatments for rheumatoid arthritis, it may be difficult to choose the best treatment option or combination of treatment choices for you. The first step is to understand all the treatment options for modifying the rheumatoid arthritis disease process, preventing future joint and other damage, and alleviating symptoms. Different treatment options and medications for rheumatoid arthritis come with different benefits and disadvantages or side effects. Your doctor may be the best person to explain to you and discuss with you all the different options. You can also ask your friends and family who are also suffering from rheumatoid arthritis about their treatment experiences, suggestions, and recommendations. Once you have all this information, you can make a better informed decision along with your doctor about the right rheumatoid arthritis treatment for you.