Managing flare-ups in rheumatoid arthritis: can etanercept improve disease symptoms?

This study investigated if etanercept is effective at treating flare-ups in patients with rheumatoid arthritis.

They found that etanercept reduces disease activity following flare-ups in these patients.

Rheumatoid arthritis (RA) is a long-term condition caused by inflammation. In RA, inflammation causes the damage to the joint tissue leading to pain and immobility over time. Medications used to treat RA are called disease-modifying antirheumatic drugs, or DMARDs. When treating RA, doctors use medication to improve disease symptoms. RA cannot be cured, but treatment can lead to low disease activity (LDA) or remission.

LDA or remission is the goal of RA treatment. Once a patient reaches this stage, it is recommended that RA medication (e.g. DMARDs) is reduced. There are a number of reasons for this. DMARDs, and particularly biological or bDMARDs, are expensive and have side effects. For these reasons, patients do not wish to take bDMARDs such as etanercept (ETN) for a long time. ETN blocks an inflammatory chemical called tumor necrosis factor (TNF). Disease ‘flare-ups’ are periods when disease activity increases. It has been suggested that bDMARDs could be used intermittently to manage flare-ups, for patients that do not want to take bDMARDs long-term. It is unclear if this type of approach using ETN can manage flare-ups in RA.

This study included 31 patients with RA. Patients had never been treated with a bDMARD prior to this trial. They were treated with ETN for disease flare-ups. Once LDA /remission was reached, ETN treatment stopped. Patients were assessed every 2 months for disease activity (DAS28 score) and joint damage (using x-rays). The study lasted 2 years.

13 patients remained on ETN during the trial because they did not achieve LDA. 5 patients achieved LDA after one course of ETN treatment. 18 patients required multiple ETN doses to achieve LDA. After 2 years, joint damage had not worsened in 50% of patients. Patients taking a lower dose of methotrexate (a drug that blocks several inflammatory chemicals) were 29% more likely to need multiple ETN doses.

The authors concluded that etanercept reduces disease activity following flare-ups in patients with RA.

The number of patients in this study was very small. Larger studies are needed for more conclusive results.

If you have any concerns regarding RA treatment, please consult with your physician.