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Management of rheumatoid arthritis: the 2012 perspective

  • Review Article
  • Published:
Modern Rheumatology

Abstract

Management of rheumatoid arthritis (RA) has improved over the last 10 years. These changes have been monitored in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) observational cohort, and clinical remission has become a realistic goal. However, we should recognize that the ultimate goal of treatment is to improve long-term outcomes. These improvements have been achieved not only by new drugs, but also by the overall approach toward treating patients. Biologics in RA have been successful; however, safety concerns and pharmacoeconomical issues are still debated. Protein kinase inhibitors have been developed, and can be called “molecular-targeting antirheumatic drugs” (MTARDs), as opposed to “disease-modifying antirheumatic drugs.” In comparison with biologics, oral MTARDs should be less expensive; however, their safety profile should be confirmed. Considering the limitations of randomized trials, it is encouraged to conduct studies based on daily practice. It is time to consider the application of the evidence generated from “our” patients to patients in daily practice, namely institute-based medicine as opposed to evidence-based medicine, of which “IORRA-based medicine” would be representative. Finally, there remains much for us rheumatologists to do for our patients, including patient-perspective approaches.

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References

  1. Yamanaka H, Tohma S. Potential impact of observational cohort studies in Japan on rheumatoid arthritis research and practice. Mod Rheumatol. 2006;16(2):75–6.

    Article  PubMed  Google Scholar 

  2. Yamanaka H. A cohort study of clinical care in rheumatoid arthritis: the IORRA study. JMAJ. 2009;52(1):54–6.

    Google Scholar 

  3. Yamanaka H, Inoue E, Singh G, Tanaka E, Nakajima A, Taniguchi A, et al. Improvement of disease activity of rheumatoid arthritis patients from 2000 to 2006 in a large observational cohort study IORRA in Japan. Mod Rheumatol. 2007;17(4):283–9.

    Article  PubMed  Google Scholar 

  4. Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LH, Funovits J, American College of Rheumatology; European League Against Rheumatism, et al. American College of Rheumatology/European League Against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Arthritis Rheum. 2011;63(3):573–86.

    Article  PubMed  Google Scholar 

  5. Felson DT, Smolen JS, Wells G, Zhang B, van Tuyl LH, Funovits J, et al. American College of Rheumatology/European League against Rheumatism provisional definition of remission in rheumatoid arthritis for clinical trials. Ann Rheum Dis. 2011;70(3):404–13.

    Article  PubMed  Google Scholar 

  6. Yamanaka H, Inoue E, Tanaka E, Nakajima A, Taniguchi A, Terai C, et al. Influence of methotrexate dose on its efficacy and safety in rheumatoid arthritis patients: evidence based on the variety of prescribing approaches among practicing Japanese rheumatologists in a single institute-based large observational cohort (IORRA). Mod Rheumatol. 2007;17(2):98–105.

    Article  PubMed  CAS  Google Scholar 

  7. Seto Y, Tanaka E, Inoue E, Nakajima A, Taniguchi A, Momohara S, et al. Studies of the efficacy and safety of methotrexate at dosages over 8 mg/week using the IORRA cohort database. Mod Rheumatol. 2011;21(6):579–93.

    Article  PubMed  CAS  Google Scholar 

  8. Nakajima A, Inoue E, Tanaka E, Singh G, Sato E, Hoshi D, et al. Mortality and cause of death in Japanese patients with rheumatoid arthritis based on a large observational cohort, IORRA. Scand J Rheumatol. 2010;39(5):360–7.

    Article  PubMed  CAS  Google Scholar 

  9. Myasoedova E, Davis JM 3rd, Crowson CS, Gabriel SE. Epidemiology of rheumatoid arthritis: rheumatoid arthritis and mortality. Curr Rheumatol Rep. 2010;12(5):379–85.

    Article  PubMed  Google Scholar 

  10. Adams R, Walsh C, Veale D, Bresnihan B, FitzGerald O, Barry M. Understanding the relationship between the EQ-5D, SF-6D, HAQ and disease activity in inflammatory arthritis. Pharmacoeconomics. 2010;28(6):477–87.

    Article  PubMed  Google Scholar 

  11. Smolen JS, Landewé R, Breedveld FC, Dougados M, Emery P, Gaujoux-Viala C, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis. 2010;69(6):964–75.

    Article  PubMed  CAS  Google Scholar 

  12. Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM, et al. 2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res. 2012;64(5):625–39.

    Google Scholar 

  13. Aletaha D, Neogi T, Silman AJ, Funovits J, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9):1580–8.

    Article  PubMed  Google Scholar 

  14. Tanaka E, Mannalithara A, Inoue E, Hara M, Tomatsu T, Kamatani N, et al. Efficient management of rheumatoid arthritis significantly reduces long-term functional disability. Ann Rheum Dis. 2008;67(8):1153–8.

    Article  PubMed  CAS  Google Scholar 

  15. Smolen JS, Aletaha D, Bijlsma JW, Breedveld FC, Boumpas D, Burmester G, T2T Expert Committee, et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis. 2010;69(4):631–7.

    Article  PubMed  Google Scholar 

  16. Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, Schirmer M, Salvarani C, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012;64(4):943–54.

    Article  PubMed  Google Scholar 

  17. Fukae J, Kon Y, Henmi M, Sakamoto F, Narita A, Shimizu M, et al. Change of synovial vascularity in a single finger joint assessed by power Doppler sonography correlated with radiographic change in rheumatoid arthritis: comparative study of a novel quantitative score with a semiquantitative score. Arthritis Care Res (Hoboken). 2010;62(5):657–63.

    Article  Google Scholar 

  18. Kievit W, Fransen J, Oerlemans AJ, Kuper HH, van der Laar MA, de Rooij DJ, et al. The efficacy of anti-TNF in rheumatoid arthritis, a comparison between randomised controlled trials and clinical practice. Ann Rheum Dis. 2007;66(11):1473–8.

    Article  PubMed  CAS  Google Scholar 

  19. Aaltonen KJ, Virkki LM, Malmivaara A, Konttinen YT, Nordström DC, Blom M. Systematic review and meta-analysis of the efficacy and safety of existing TNF blocking agents in treatment of rheumatoid arthritis. PLoS One. 2012;7(1):e30275.

    Article  PubMed  CAS  Google Scholar 

  20. Singh JA, Beg S, Lopez-Olivo MA. Tocilizumab for rheumatoid arthritis. Cochrane Database Syst Rev. 2010;(7):CD008331.

  21. Tak PP, Kalden JR. Advances in rheumatology: new targeted therapeutics. Arthritis Res Ther. 2011;25(13 Suppl 1):S5.

    Google Scholar 

  22. Buch MH, Emery P. New therapies in the management of rheumatoid arthritis. Curr Opin Rheumatol. 2011;23(3):245–51.

    Article  PubMed  CAS  Google Scholar 

  23. Gómez-Reino JJ, Carmona L, Angel Descalzo M; Biobadaser Group. Risk of tuberculosis in patients treated with tumor necrosis factor antagonists due to incomplete prevention of reactivation of latent infection. Arthritis Rheum. 2007;57(5):756–61.

  24. Harigai M, Koike R, Miyasaka N, Pneumocystis Pneumonia under Anti-Tumor Necrosis Factor Therapy (PAT) Study Group. Pneumocystis pneumonia associated with infliximab in Japan. N Engl J Med. 2007;357(18):1874–6.

    Article  PubMed  CAS  Google Scholar 

  25. Tanaka E, Inoue E, Hoshi D, Nakajima A, Momohara S, Taniguchi A, et al. Analysis of medical cost for care of rheumatoid arthritis patients before and after usage of the biologics using a large cohort database, IORRA (abstract). Mod Rheumatol. 2009;19(Suppl):S46.

    Google Scholar 

  26. Gu N, Yi S, Kim TE, Kim J, Shin SG, Jang IJ, et al. Comparative pharmacokinetics and tolerability of branded etanercept (25 mg) and its biosimilar (25 mg): a randomized, open-label, single-dose, two-sequence, crossover study in healthy Korean male volunteers. Clin Ther. 2011;33(12):2029–37.

    Article  PubMed  CAS  Google Scholar 

  27. Fleischmann R. Novel small-molecular therapeutics for rheumatoid arthritis. Curr Opin Rheumatol. 2012 (Epub ahead of print).

  28. Yazici Y, Regens AL. Promising new treatments for rheumatoid arthritis—the kinase inhibitors. Bull NYU Hosp Jt Dis. 2011;69(3):233–7.

    PubMed  Google Scholar 

  29. Okamoto H, Kobayashi A. Spleen tyrosine kinase (Syk) inhibitor for rheumatoid arthritis. N Engl J Med. 2011;364(1):83–4.

    Google Scholar 

  30. Lucet IS, Fantino E, Styles M, Bamert R, Patel O, Broughton SE, et al. The structural basis of Janus kinase 2 inhibition by a potent and specific pan-Janus kinase inhibitor. Blood. 2006;107(1):176–83.

    Google Scholar 

  31. Kremer JM, Cohen S, Wilkinson BE, Connell CA, French JL, Gomez-Reino J, et al. A phase 2B dose-ranging study of the oral JAK inhibitor tofacitinib (CP-690,550) versus placebo in combination with background methotrexate in patients with active rheumatoid arthritis and inadequate response to methotrexate alone. Arthritis Rheum. 2012;64(4):970–81.

    Article  PubMed  CAS  Google Scholar 

  32. Furst DE. Observational cohort studies and well controlled clinical trials–we need them both! J Rheumatol. 2004;31(8):1476–7.

    PubMed  Google Scholar 

  33. Greenberg JD, Kremer JM, Curtis JR, Hochberg MC, Reed G, Tsao P, CORRONA Investigators, et al. Tumour necrosis factor antagonist use and associated risk reduction of cardiovascular events among patients with rheumatoid arthritis. Ann Rheum Dis. 2011;70(4):576–82.

    Article  PubMed  Google Scholar 

  34. Camacho EM, Lunt M, Farragher TM, Verstappen SM, Bunn DK, Symmons DP. The relationship between oral contraceptive use and functional outcome in women with recent-onset inflammatory polyarthritis: results from the Norfolk Arthritis Register. Arthritis Rheum. 2011;63(8):2183–91.

    Article  PubMed  CAS  Google Scholar 

  35. Ljung L, Simard JF, Jacobsson L, Rantapää-Dahlqvist S, Anti-Rheumatic Therapy in Sweden (ARTIS) Study Group. Treatment with tumor necrosis factor inhibitors and the risk of acute coronary syndromes in early rheumatoid arthritis. Arthritis Rheum. 2012;64(1):42–52.

    Article  PubMed  CAS  Google Scholar 

  36. Baghai M, Osmon DR, Wolk DM, Wold LE, Haidukewych GJ, Matteson EL. Fatal sepsis in a patient with rheumatoid arthritis treated with etanercept. Mayo Clin Proc. 2001;76(6):653–6.

    PubMed  CAS  Google Scholar 

  37. Kirwan J, Heiberg T, Hewlett S, Hughes R, Kvien T, Ahlmèn M, et al. Outcomes from the patient perspective workshop at OMERACT 6. J Rheumatol. 2003;30(4):868–72.

    PubMed  Google Scholar 

  38. van Tuyl LH, Smolen JS, Wells GA, Scholte-Voshaar M, Hoogland W, Boers M. Patient perspective on remission in rheumatoid arthritis. J Rheumatol. 2011;38(8):1735–8.

    Article  PubMed  Google Scholar 

  39. de Wit MP, Smolen JS, Gossec L, van der Heijde DM. Treating rheumatoid arthritis to target: the patient version of the international recommendations. Ann Rheum Dis. 2011;70(6):891–5.

    Article  PubMed  Google Scholar 

  40. Hood L. A personal journey of discovery: developing technology and changing biology. Annu Rev Anal Chem (Palo Alto Calif). 2008;1:1–43.

    Article  CAS  Google Scholar 

  41. Hood L, Friend SH. Predictive, personalized, preventive, participatory (P4) cancer medicine. Nature Rev Clin Oncol. 2011;8:184–7.

    Google Scholar 

  42. Okada Y, Terao C, Ikari K, Kochi Y, Ohmura K, Suzuki A, et al. Meta-analysis identifies nine new loci associated with rheumatoid arthritis in the Japanese population. Nat Genet. 2012;25;44(5):511–6.

    Google Scholar 

  43. Terao C, Ohmura K, Kochi Y, Ikari K, Maruya E, Katayama M, et al. A large-scale association study identified multiple HLA-DRB1 alleles associated with ACPA-negative rheumatoid arthritis in Japanese subjects. Ann Rheum Dis. 2011;70(12):2134–9.

    Article  PubMed  CAS  Google Scholar 

  44. Nishimoto K, Ikari K, Kaneko H, Tsukahara S, Kochi Y, Yamamoto K, et al. Association of EMCN with susceptibility to rheumatoid arthritis in a Japanese population. J Rheumatol. 2011;38(2):221–8.

    Article  PubMed  CAS  Google Scholar 

  45. Kochi Y, Okada Y, Suzuki A, Ikari K, Terao C, Takahashi A, et al. A regulatory variant in CCR6 is associated with rheumatoid arthritis susceptibility. Nat Genet. 2010;42(6):515–9.

    Article  PubMed  CAS  Google Scholar 

  46. Shimane K, Kochi Y, Horita T, Ikari K, Amano H, Hirakata M, et al. The association of a nonsynonymous single-nucleotide polymorphism in TNFAIP3 with systemic lupus erythematosus and rheumatoid arthritis in the Japanese population. Arthritis Rheum. 2010;62(2):574–9.

    PubMed  CAS  Google Scholar 

  47. Nishimoto K, Kochi Y, Ikari K, Yamamoto K, Suzuki A, Shimane K, et al. Association study of TRAF1-C5 polymorphisms with susceptibility to rheumatoid arthritis and systemic lupus erythematosus in Japanese. Ann Rheum Dis. 2010;69(2):368–73.

    Article  PubMed  CAS  Google Scholar 

  48. Carton J. The extreme future. London: A Plume Book; 2007.

    Google Scholar 

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Acknowledgments

The IORRA cohort was conducted through the effort and collaboration of all staff at the Institute of Rheumatology, Tokyo Women’s Medical University. IORRA has been supported by an unrestricted grant from Asahikasei Kuraray Medical Co., Ltd., Abbott Japan Co., Ltd., Asahikasei Pharma Corporation, Astellas Pharma Inc., AstraZeneca K.K., Bristol-Myers Squibb, Chugai Pharmaceutical Co., Ltd., Daiichi Fine Chemical Co., Ltd., Daiichi Sankyo Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Dentsu, Sudler & Hennessey Inc., Eisai Co., Ltd., GlaxoSmithKline K.K., Hisamitsu Pharmaceutical Co., Inc., Janssen Pharmaceutical K.K., Japan Tobacco Inc., Kaken Pharmaceutical Co., Ltd., Kissei Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co. Ltd., Mitsubishi Chemical Medience Corporation, Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co., Ltd., MSD K.K., Mundipharma K.K., Nippon Chemiphar Co., Ltd., Nippon Shinyaku Co., Ltd., Novartis Pharma K.K., Otsuka Pharmaceutical Co., Ltd., Pfizer Japan Inc., Sanofi-Aventis K.K., Santen Pharmaceutical Co., Ltd., Sanwa Kagaku Kenkyusho Co., Ltd., Sekisui Medical Co., Ltd., Taishotoyama Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited, Torii Pharmaceutical Co., Ltd., UCB Japan Co. Ltd., and ZERIA Pharmaceutical Co., Ltd.

Conflict of interest

H.Y. has been received speaking fee and/or consulting fee from Abbott, AstraZeneca, Bristol-Myers, Chugai Pharmaceutical, Daiichi Sankyo, Eisai, Janssen Pharmaceutical, Mitsubishi Tanabe, Otsuka Pharmaceutical, Pfizer Japan, Takeda Pharmaceutical, Teijin, and UCB. All other authors have declared no conflicts of interest.

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Authors and Affiliations

  1. Institute of Rheumatology, Tokyo Women’s Medical University, 10-22 Kawada-cho, Shinjuku-ku, Tokyo, 162-0054, Japan

    Hisashi Yamanaka, Yohei Seto, Eiichi Tanaka, Takefumi Furuya, Ayako Nakajima, Katsunori Ikari, Atsuo Taniguchi & Shigeki Momohara

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  1. Hisashi Yamanaka
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  2. Yohei Seto
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  3. Eiichi Tanaka
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  8. Shigeki Momohara
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Correspondence to Hisashi Yamanaka.

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Yamanaka, H., Seto, Y., Tanaka, E. et al. Management of rheumatoid arthritis: the 2012 perspective. Mod Rheumatol 23, 1–7 (2013). https://doi.org/10.1007/s10165-012-0702-1

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