Halting arthritis damage

By LINDA SEARING

THE QUESTION: As treatment of rheumatoid arthritis has expanded from simply relieving the chronic pain of inflamed joints to also preventing the destruction of bone and cartilage, an array of drugs has become available, for use alone or in combination. What strategy works best?

THIS STUDY randomly assigned 508 adults, mostly women, recently diagnosed with rheumatoid arthritis to one of four types of medication programs:

methotrexate alone, switching to a different disease-modifying, anti-rheumatic drug (DMARD) if needed; a step-up program that starts with methotrexate but adds other DMARDs and the steroid prednisone; an initial combination of methotrexate, sulphasalazine (an anti-inflammatory) and prednisone; a combination of methotrexate and infliximab, a drug that blocks a substance (tumor necrosis factor) that causes inflammation. After a year, the ability to function had improved in all groups, with the disease in remission in 32 percent of the participants. But more people from the third and fourth groups - those who had taken a combination of drugs from the start - improved, and they improved more quickly, than the others. Compared with hand and foot X-rays taken at the start of the study, those two groups also showed less progression of joint damage, with no progression shown for 87 percent and 93 percent of the groups, respectively, compared with 67 percent for the first group and 73 percent for the second group. WHO MAY BE AFFECTED BY THESE FINDINGS? People with rheumatoid arthritis, which most often begins between ages 30 and 50. Women are nearly three times more likely to get the disease, but it tends to affect men more severely. CAVEATS: About 41 percent of the participants, roughly divided equally among the groups, reported side effects, mainly gastrointestinal and skin problems. The study was funded in part by Centocor and Schering-Plough, which had paid fees to one author. FIND THIS STUDY: November issue of Arthritis & Rheumatism; abstract available online at |interscience.wiley.com/journal|/arthritis. LEARN MORE about rheumatoid arthritis at arthritis.org and mayoclinic.com. THE QUESTION: In laboratory experiments, it appears that statins - which are taken to lower cholesterol and prevent heart disease - might also prevent cancer by inhibiting the growth and spread of tumors. Has evidence of this emerged among the millions of Americans who take this drug every day? THIS STUDY analyzed medical data on 79,994 women, with an average age in the mid-60s, who were cancer-free at the start of the study. During a 12-year period, breast cancer occurred in 3,177 of the women, including 1,727 who took statins. Those taking statins were no more - and no less - likely to have breast cancer than women not taking the drug. The length of time statins were taken did not alter the results. WHO MAY BE AFFECTED BY THESE FINDINGS? Women who take statins. Women are more apt to be taking this type drug, as they generally have higher cholesterol levels than men. CAVEATS: The study did not differentiate among different types of statins, and it did not consider other forms of cancer. It remains unclear whether taking the drug for longer than 12 years would affect the results.