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I. Arava Fact File

Arava was introduced by Aventis.

The Sanofi-Aventis Group is the world's 3rd largest pharmaceutical company, ranking number 1 in Europe. Aventis is a part of the Sanofi-Aventis Group. Backed by a world-class R&D organization, Sanofi-Aventis is developing leading positions in seven major therapeutic areas: cardiovascular disease, thrombosis, oncology, diabetes, central nervous system, internal medicine, and vaccines.

II. Arava Medication

Generic Arava (leflunomide), a medication classified as a disease-modifying antirheumatic drug (DMARD), helps improve Rheumatoid Arthritis (RA) symptoms such as joint swelling and tenderness. But unlike many symptom relievers that only help relieve pain and swelling, Arava medication actually helps slow the progression of joint damage caused by RA. So, while there is no cure for RA, Arava medication may help prevent RA from getting worse.

Study results show that in adult RA patients, Arava medication significantly reduces pain and morning stiffness in the joints. After 5 years of treatment with Generic Arava, researchers noted a considerable improvement in study patients' RA symptoms.

Study results also show Arava medication improves patients' physical function. After 1 year of treatment, researchers noted an improvement in study patients' ability to perform daily tasks such as eating, dressing, bathing and walking. Patients who continued taking Arava medication for a second year maintained improved physical function.

Study results also prove the ability of Arava medication to slow the progression of RA. After 6 months of treatment, Arava medication already had started to slow the rate of bone and cartilage damage in study patients' joints. After 1 year, patients showed very little progression of joint damage. And after 2 years, X-rays showed that few patients in the study had newly damaged joints during the second year of treatment.

Disease-modifying antirheumatic drugs (DMARD's)

Disease-modifying antirheumatic drugs are also known as remission-inducing agents.

DMARD drugs may slow down the progression of the disease and diminish the symptoms.

  • In some cases it can reduce both the signs and symptoms of the disease in the joints and soft-tissue.
  • Laboratory abnormalities may return to normal.
  • It does not lead to remission in all cases.
  • They may have serious side-effects on the body.

Disease-modifying antirheumatic drugs (DMARD) include:

  • Methotrexate
  • Arava - Leflunomide
  • Sulphasalazine
  • Gold -- parenteral (Myocrisin)
  • Gold -- oral (auranofin)
  • Antimalarials -- Hydroxychloroquine, Chloroquine phosphate, Chloroquine sulphate
  • Antibiotics - Minocycline
  • D-Penicillamine
  • Azathioprine
  • Cyclophosphamide
  • Cyclosporine

New agents recently introduced include:

  • Leflunomide / Arava
  • Anti TNF - biological agents: etanercept /enbrel and infliximab/Ca2

In addition Disease modifying therapy are increasingly recognized for use in combination therapy.

Rheumatoid Arthritis (RA): Information
Rheumatoid Arthritis (RA) is the most common type of arthritis triggered by the immune system.

 

Diagram 1: The normal joint structure is pictured on the left. On the right is the joint affected by rheumatoid arthritis, which has swelling of the synovium that can lead to damage to cartilage and bone.

Rheumatoid arthritis (RA) is an autoimmune disease where the body's natural immune system does not operate properly, resulting in the immune system attacking healthy joint tissue and causing inflammation and subsequent joint damage. This typically chronic disease can affect the entire body, specifically targeting joints and sometimes, internal organs.

Rheumatoid Arthritis (RA) is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. RA is characterized by the inflammation of the membrane lining the joint, which causes pain, stiffness, warmth, redness and swelling. The inflamed joint lining, the synovium, can invade and damage bone and cartilage. Inflammatory cells release enzymes that may digest bone and cartilage. The involved joint can lose its shape and alignment, resulting in pain and loss of movement.

 

 

 

Diagram 2: Rheumatoid arthritis affects the wrist and the small joints of the hand including the knuckles and the middle joints of the fingers.

The stiffness seen in active Rheumatoid Arthritis (RA) is typically worst in the morning and may last anywhere from one to two hours to the entire day. This long period of morning stiffness is an important diagnostic clue, as not many other arthritic diseases behave this way. For example, osteoarthritis does not generally cause prolonged morning stiffness. While RA can affect any joint, the small joints in the hands and feet tend be involved more frequently than others. This produces a pattern of joint disease that rheumatologists regard as characteristic of Rheumatoid Arthritis (RA).

Symptoms of Rheumatoid Arthritis (RA)

Symptoms of RA include inflammation of joints, swelling, difficulty moving and pain. Other symptoms that affect the entire body include loss of appetite, fever, loss of energy, low-grade fevers, dry eyes and mouth from an associated condition known as Sjogren's syndrome (Sjögren's syndrome is an inflammatory disease that can affect many different parts of the body, but most often affects the tear and saliva glands) and anemia.

Premature in the disease, people may observe general fatigue, soreness, stiffness and aching. Pain and swelling may occur in the same joints on both sides of the body and will usually start in the hands or feet. Rheumatoid Arthritis (RA) affects the wrist and many of the hand joints, but usually not the joints that are closest to the fingernails (except the thumb). RA also can affect elbows, shoulders, neck, knees, hips and ankles. It tends to persist over prolonged periods of time, and over time, inflamed joints may become damaged. Other features include lumps, called rheumatoid nodules, under the skin in areas that receive pressure, such as the back of the elbows.

Causes of Rheumatoid Arthritis (RA)

Rheumatoid Arthritis (RA) is classified as an autoimmune disease, which develops because certain cells of the immune system malfunction and attack healthy joints. While the cause of Rheumatoid Arthritis (RA) remains unknown, exciting and rapidly advancing research is revealing the factors that are important in producing inflammation.

The main focus of the inflammation is in the synovium, which is the lining tissue of the joint. Inflammatory chemicals released by the immune cells cause swelling and damage to cartilage and bone. This research is giving us a enhanced understanding of the immune and genetic factors that may be involved in the disease. As a result of this work, new medications have been developed that specifically block certain signals in the body from the immune system that are important in causing RA symptoms and joint damage.

Treatment of Rheumatoid Arthritis (RA)

Therapy for patients with Rheumatoid Arthritis (RA) has improved dramatically over the past 25 years. Current treatments offer most patients good to excellent relief of symptoms and the ability to continue to function at or near normal levels. Since there is no cure for Rheumatoid Arthritis (RA), the goal of treatment is to minimize patients' symptoms and disability by introducing appropriate medical therapy early on, before the joints are permanently damaged. No single therapy is effective for all patients, and many patients will need to change treatment strategies during the course of their disease.

Successful management of Rheumatoid Arthritis (RA) requires early diagnosis and, at times, aggressive treatment. To quickly reduce joint inflammation and symptoms, first-line treatment usually consists of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin and others), naproxen (Naprosyn, Aleve), celecoxib (Celebrex) and many others. In addition, corticosteroids such as prednisone (Deltasone and others) may be given orally at low doses or via injection into the joints.

However, all Rheumatoid Arthritis (RA) patients with persistent swelling in the joints are candidates for treatment with disease-modifying anti-rheumatic drugs (DMARDs), often used in conjunction with NSAIDs and/or low dose corticosteroids. DMARDs have greatly improved the symptoms and function as well as the quality of life for the vast majority of patients with RA. DMARDs include methotrexate (Rheumatrex and Folex), leflunomide (Arava), hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), gold given orally (Auranofin) or intramuscularly (Myochrisine), minocycline (Minocin, Dynacin and Vectrin), azathiaprine (Imuran), and cyclosporine (Sandimmune and Neoral).

The optimal treatment of Rheumatoid Arthritis (RA) often requires more than medication alone. Proper treatment requires comprehensive, coordinated care, patient education and the expertise of a number of providers, including rheumatologists, primary care physicians, and physical and occupational therapists.

Side effects of disease-modifying anti-rheumatic drugs(DMARD)

Side effects of disease-modifying anti-rheumatic drugs (DMARD) (methotrexate, leflunomide, hydroxy/chloroquine, sulfasalazine) include unspecifical gastrointestinal symptoms like nausea, vomiting and diarrhea as well as induction of ulcerative mucosal lesions (methotrexate) and occurrence of a hepatopathy.

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