Rheumatoid arthritis (RA) typically is a chronic autoimmune complication characterized by inflammation of the joints and nearby tissues. As per some evidence infection, genetics, and hormone changes may be associated with this chronic autoimmune disease.
Roughly 13 million Americans are estimated to have Rheumatoid arthritis. Although it can occur at any age, the peak age of onset is between 30 and 55 years. Women have this disease (RA) 2 to 3 times more than men.
The signs/symptoms of Rheumatoid arthritis usually appear bilaterally with fingers, wrists, knees, ankles, and feet being the most frequent sites of disease. The disease rheumatoid arthritis typically has a slow onset that is characterized by minor joint pain and stiffness, swelling, and fatigue. As time passes, the affected joints may develop a restricted range of motion and gradually become deformed.
Other probable symptoms of this autoimmune disease can include chest pain while breathing, dry eyes, and mouth, discharge of the eyes, numbness, nodules under the skin, tingling/burning of the hands and feet, and difficulty sleeping.
Economic Burden of RA:
Rheumatoid arthritis (RA) is associated with a significant economic burden, including work disability and functional impairment. A bit higher percentage of individuals with this autoimmune disease report work disability compared to those who are normal. An estimated 66% of individuals with this disease lose an average of 39 working days each year. The costs to the US economy in terms of work-related disability can amount to billions of dollars yearly.
Functional impairment is the most significant predictor of premature mortality and work disability in individuals with rheumatoid arthritis, Approximately 25% of individuals with this disease (RA) face a reduction in their income.
A Complex Diagnosis:
A couple of helpful tests are the rheumatoid factor test and the anti-CCP antibody test, but at least 30% of individuals with RA have negative results on these two tests.
Other tests that can lead to supporting evidence for the diagnosis of Rheumatoid arthritis include a CBC, C-reactive protein (CCP), erythrocyte sedimentation rate (ESR), joint x-rays, joint ultrasound or magnetic resonance imaging (MRI), and synovial fluid analysis.
The Approach to Rheumatoid Arthritis Treatment:
Rheumatoid arthritis (RA) typically requires lifelong treatment, which includes medications, exercise, education, physical therapy, and possible surgery. As per experts, early, aggressive treatment can delay the destruction of joints.
Nonbiologic Drugs: The first-line treatment of rheumatoid arthritis specifically entails a nonbiologic disease-modifying antirheumatic drug (DMARD), most typically methotrexate. Certain other nonbiologic DMARDs include chloroquine and leflunomide. Anti-inflammatory drugs are also considered including aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen and ibuprofen. These medicines are proven to be effective in relieving signs/symptoms.
Biologic Drugs: Over the past decade or so, biologic DMARDs have become available. These agents can be promising in order treat RA. Biologics are mainly reserved for those with a suboptimal response to nonbiologic DMARDs or other drugs. These are given subcutaneously or intravenously.
Tofacitinib Approved for Rheumatoid Arthritis: TofaÂcitinib (Xeljanz) is approved as a biologic agent for the treatment of rheumatoid arthritis. It is a Janus kinase (JAK) inhibitor and the first oral biologic agent for rheumatoid arthritis. The drug was approved by the US FDA in November 2012 for the treatment of adult individuals with moderate-to-severe active rheumatoid arthritis who have not had an adequate response to, or are not tolerant of, methotrexate. The approval was granted as monotherapy or along with medicine methotrexate or other nonbiologic DMARDs. This medicine is supplied in tablet form.
Mechanism of Action: Tofacitinib 5 mg tablet is an oral JAK inhibitor. It has a novel mechanism of action that targets JAK1/2/3. Unlike other existing biologics that are designed to target extracellular molecules (proinflammatory cytokines), tofacitinib treatment targets the intracellular signaling pathways that work collectively in the inflammatory cytokine network.
Dosing Schedule: The recommended dose of tofacitinib is 5 mg twice daily. Tablets should be taken by mouth without food. The dosage can be scaled down to 5 mg once daily for those with moderate or severe renal insufficiency, those with moderate hepatic impairment, those taking potent inhibitors of the cytochrome (CY)P3A4 enzyme, and those receiving single or multiple concomitant drugs that result in moderate inhibition of CYP3A4 and in potent inhibition of CYP2C19.
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Conclusion:
Tofacitinib is an oral biologic agent for the treatment of rheumatoid arthritis. A JAK inhibitor that targets JAK1/2/3, tofacitinib can be prescribed as a monotherapy or along with the drug methotrexate or with other nonbiologic DMARDs in adult individuals with moderate-to-severe rheumatoid arthritis who have had no adequate response to treatment methotrexate.
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