New therapies designed to fight the biology behind rheumatoid arthritis (search) lead the list of the top 10 arthritis advances of 2004, according to the Arthritis Foundation.

Recent clinical trials show the biologic drug Rituxan (search), which is currently approved by the FDA for the treatment of non-Hodgkin’s lymphomas (search), shows promise in treating rheumatoid arthritis. Another biologic drug, known as abatacept, also appears to help those who don’t respond to other rheumatoid arthritis treatments.

Also high on the list of arthritis advances is the discovery of a common genetic link between immune disorders, such as rheumatoid arthritis, lupus (search), diabetes, and thyroid disease.

“Breakthrough advances in 2004 offer hope to people with arthritis and provide a glimpse of what is possible in the future,” says John H. Klippel, MD, president and CEO of the Arthritis Foundation, in a news release. “As the number of people with arthritis reaches epidemic proportions, advances in research, public health, and public policy are more important than ever to preventing, controlling, and eventually curing the nation’s No. 1 cause of disability.”

Top Arthritis Advances

In compiling its list of the top arthritis advances of 2004, the Arthritis Foundation sought input from physicians and researchers in a variety of different arthritis specialties, as well as the American College of Rheumatology, the American Academy of Orthopaedic Surgeons, and the CDC.

Here are their top 10 choices:

1. New Biologic Drugs Show Promise in Rheumatoid Arthritis.

Two experimental drugs that selectively target harmful immune cells involved in rheumatoid arthritis have been successful in recent clinical trials. Researchers say these drugs bring them closer to stopping the progression of the disease.

In 2004, researchers showed that a brief course of treatment with Rituxan, either alone or in combination with methotrexate (search) or cyclophosphamide (search), was safe and effective in relieving rheumatoid arthritis symptoms for at least six months. Other research suggested the value of using abatacep (search)t, part of a new class of drugs known as co-stimulation modulators that block the activation of a type of immune cell known as T-cells.

Abatacept appears to be a useful alternative therapy for people with rheumatoid arthritis who have failed on methotrexate and/or other medications called biologic agents, which specifically target parts of the immune system that lead to inflammation, as well as joint and tissue damage.

2. Gene Variation Linked to Autoimmune Disorders.

Scientists discovered a variation in a gene linked with an increased risk for rheumatoid arthritis, lupus, and other disorders that affect the immune system, which may explain why these conditions tend to group in families. This discovery may eventually lead to new treatments for immune disorders.

3. Biological Marker for Rheumatoid Arthritis Found.

Researchers demonstrated that more than 90 percent of a group of people with “undifferentiated arthritis” who tested positive on a simple “anti-CCP2” (search) antibody blood test developed rheumatoid arthritis within three years. Such a tool may help alert physicians to those patients who may require more intensive monitoring, screening, and early treatment.

4. Medicare Coverage of Self-Injected Medications Secured.

A new law implemented in 2004 allows up to 50,000 people with Medicare who have serious and life-threatening conditions, including rheumatoid and psoriatic arthritis (search), to obtain medications at a reduced cost. The new Medicare legislation means patients who take self-injected medications, such as the biologics Enbrel, Humira, and Kineret, can save thousands of dollars on medications to improve their arthritis.

5. Effectiveness of Weight Loss and Physical Activity Confirmed.

New research showed that exercise and diet together significantly improve physical function and reduce knee pain from osteoarthritis (search) of the knee in people over age 60 that are overweight or obese compared with either therapy alone.

6. Antibiotic Slows Osteoarthritis Progression.

Research showed that an antibiotic, doxycycline (search), which is used to treat a variety of infections, also inhibits the breakdown of joint cartilage in osteoarthritis.

7. Arthritis Prevention, Control, and Cure Act of 2004 Introduced.

The first arthritis-specific legislation in more than 30 years expands the federal government's efforts to prevent, treat, and find a cure for arthritis.

8. First Set of Quality Indicators for Arthritis Pain Treatment Introduced.

Fifty-one measures of quality health care for people with osteoarthritis, rheumatoid arthritis, or anyone using pain medication were introduced in 2004 by a multidisciplinary panel of nationally recognized experts

9. New Treatment Effective in Slowing Bone Erosion.

Data reported in 2004 show the potential value of a new drug based on new insights about bone biology. AMG 162 (search) is a human antibody designed to block an inflammatory chemical (RANKL) that contributes to the destruction of bone in people with a variety of conditions including osteoporosis, rheumatoid arthritis, and those taking corticosteroids (search).

10. Measures Mandated to Prevent Wrong-Site Surgery.

It is estimated that one in five orthopaedic surgeons will operate on the wrong site in his or her career. To improve patient safety, preoperative surgical site marking became mandatory in U.S. hospitals and surgical centers.

By Jennifer Warner, reviewed by Brunilda Nazario, MD

SOURCE: News release, Arthritis Foundation.