Unprecedented range of therapeutic options for rheumatic diseases is now available — challenge is to make them accessible

From The Lancet:

Small molecule inhibitors of Janus kinase (JAK)

Much of the recent knowledge of the underlying mechanisms that drive rheumatoid arthritis and other diseases has come from preclinical studies of key cytokines, including tumour necrosis factor alpha, interleukin 6, and granulocyte–macrophage colony-stimulating factor. New Janus kinase (JAK) inhibitors include tofacitinib and baricitinib which are approved for treatment of arthritis and other rheumatoid diseases.

Aggressive treatment, early

For a complex, progressive, chronic disease such as rheumatoid arthritis, the timing of intervention is critical. In the past, the recommended treatment approach was slow and steady, referred to as “the pyramid”—ie, a base of physical therapy and non-pharmacological interventions, followed by conservative treatment with non-steroidal anti-inflammatory drugs, then glucocorticoid steroids and, finally, administration of a conventional disease-modifying antirheumatic drug (DMARD). This concept is now inverted. Intensive intervention, initiated earlier, with conventional and biological DMARDs is increasingly recommended.

Biologics and small molecule inhibitors are added to the therapeutic arsenal. Focus on early window of opportunity for management, with treat-to-target approaches that include rapid intervention, and adjustment of medications for patients who do not achieve remission within 6 months. The new campaign, “Don't delay, connect today”, highlights this approach.

Affordability

Biosimilars might provide affordable options.

An unprecedented range of therapeutic options for rheumatic diseases is now available—the new challenge is to make them accessible.

References:

A platinum age for rheumatology - The Lancet http://buff.ly/2slCFPw

Fibromuscular Dysplasia - Cleveland Clinic video

Fibromuscular dysplasia (FMD) is an angiopathy that affects medium-sized arteries predominantly in young. Renal involvement occurs in 60-75%, cerebrovascular involvement in 25-30%, visceral involvement in 9%, and arteries of the limbs in about 5%.



Cleveland Clinic physician, Dr. Gornik and Pam Mace from FMDSA answer questions about fibromuscular dysplasia (FMD) on this spreecast video chat (6/2014).

References:

Fibromuscular Dysplasia (FMD): Causes, Types, Symptoms and Treatment - Cleveland Clinic http://bit.ly/1sRTXKw