RA News Headlines, Vol. 6: Ibuprofen for Pain, Orencia Shots, New RA test, RA Inflammation Increases CV Risk
4 Big Headlines for RA News
1) Ibuprofen beats acetaminophen & a combination of both in knee pain
Thanks to Dr. Kirsch for Tweeting this fantastic editorial about an arthritis pain relief study in the Annals of Rheumatic Diseases last week. The column highlights data in a new long-term study of the two most popular over-the-counter pain relievers (ibuprofen/Advil/Motrin and paracetamol /acetaminophen /Tylenol). The study is praised because it “reveals many new and important findings which should be the basis for reconsideration of the treatment of musculoskeletal conditions with over-the-counter (OTC) analgesics. It may turn out that many of our widely-held beliefs and assumptions are wrong and that the recommendation for our patients needs to be changed.”
Remarkably, this little table shows that “the high-dose combination (both drugs) was superior to paracetamol alone for pain relief, but was not superior to ibuprofen alone” on day 10.
In addition to questionnaires, patients were asked about “acceptability of pain in the past 48 h determined by asking ‘Thinking only of the pain you felt in your knee during the last 48 h, if you were to remain with that pain for the rest of your life would that be acceptable to you?’” The test group was about 900 people with arthritis of the knee.
Read more about comparing ibuprofen, acetaminophen, and combinations for arthritis pain in the original 5 year study.
2) FDA approves injectable Orencia (abatacept) after phase 3 study
This decision is no surprise. It comes after a study comparing Orencia IV with a 125 mg subcutaneous dose: the ACQUIRE trial (Abatacept Comparison of Sub(Qu)cutaneous vs. Intravenous in Inadquate Responders to Methotrexate), a Phase 3 trial of over 1,400 patients.
Although the approval was only a few weeks ago, the company reported their positive results about Orencia sub-Q last fall.
- This is the first approved at-home injection for Rheumatoid Arthritis that is not a TNF inhibitor.
- “Disease activity was measured using the ACR20 criteria, an accepted measure of drug response. A patient achieving at least 20% improvement in RA disease state is considered successful.”
- “The scientists found that 79.7% of patients receiving abatacept had new flares versus 82.5% of those on placebo.”
Many questions can be answered by reading the Orencia package insert, including description of pediatric dosing.
Read more about Orencia and the ACQUIRE trial on Drugs.com
Note: We discussed this on Facebook a few weeks ago immediately after I got a press email from someone representing Bristol-Myers Squibb. I’ve been working on a more detailed post, interviewing one of their research doctors, but wanted to make sure you all had this news. I’ve heard a couple patients discontinued successful Orencia treatment when their doctors quit using IV medications.
3) New anti-CCP test approved by FDA
“In vitro diagnostics company Axis-Shield has received the US Food and Drug Administration (FDA) 510(k) approval for its anti-CCP Elisa kit for the diagnosis of rheumatoid arthritis. The new kit increases the assay range and contains changed components for reduced manufacturing costs and improved margins.” Perhaps the tests will be more sensitive. Either way, it’s vital that GP’s learn to order them since this is the most specific and earliest indicator of RA and severity of Rheumatoid disease.
Read more about the Bio-Rad / Axis-Shield and their new anti-CCP test.
4) Inflammation tied to cardiovascular risk in Rheumatoid patients
Some studies have revealed the silent nature of RA heart disease so hurray for any about clues for reducing heart disease with RA. This one, “Cardiovascular events in early RA are a result of inflammatory burden and traditional risk factors: a five year prospective study,” followed a total of 442 newly diagnosed RA patients in northern Sweden.
Their conclusion: “The occurrence of new CV events in very early RA was explained by traditional CV risk factors and was potentiated by high disease activity. Treatment with DMARDs decreased the risk. The results may have implications for cardio-protective strategies in RA.”
Read the full report of the study of cardiovascular events in RA.
Recommended reading
- Predicting Rheumatoid Arthritis
- Reliable Sources: Orencia Cough Side Effect & Notions of e-Patients
- Rheumatoid Arthritis News, Vol.5: Men & Mortality, Vitamin D Research, New RA Meds
- Rheumatoid Arthritis News Articles, Vol. 3: Syk inhibitor, CVD Risk & Diabetes Link
Thank you Kelly for the articles, I found it very interesting on the pain relief study, perhaps for one that doesn’t have a CVD, motrin would be more beneficial for pain relief. Thank you again for your hard work with everything that you deal with alone. God bless you Girl, your in my prayers daily.
Thank you!!
Interesting stuff, thank you againg for presenting this to us here, never would have come across it otherwise!
Read with interest the study on Ibuprofen med article. It seems though that all study patients had osteo and not ra. I can’t help but wonder after I take 800mg of advil if it really does anything, dulls the pain a bit, but takes away none of the swelling. Is there swelling in osteo? I had always thought that ibuprofen took away swelling, and tylenol took away pain. Advil always worked for everything pre ra, so after my very first flare, and I took it and it did nothing, I knew something was very wrong long before I went to the dr.
Yes, I realize the test group on pain was knee arthritis (what is now commonly called OA). The reason for choosing a group who all had the same pain problem was, I assumed, so that the researchers could try to find a homogeneous group. I think they meant to imply that the same trends that they noticed for pain relief only could possibly be applied to other pain – at least thats what the title & abstract seemed to imply.
I’ve read conflicting comments on whether arthritis/OA can be inflammatory, but I’d agree with you that RA is obviously more inflammatory. Much of RA pain (most?) according to patients is not related to the swelling – they don’t correlate completely for sure. You’ll hear many patients have 1 without the other at various times. That tells me one is not necessarily always the cause of the other.
Ibuprofen is known (before this study) for being better at taking away pain than Tylenol. I think there are other studies, but also because Tylenol doesn’t do much for inflammation and much of it is lost in the liver in many people. Agreed, 800mg is the ibu dose that I use also. RA is thought to be one of the most painful conditions so it makes sense that if we have inflammation all over the body and intense pain, that a higher dose is needed. I find it does reduce swelling for me sometimes, but not always. Like you said, it only dulls the pain a bit. But it’s a big help if you live in constant flare that the dmards don’t stop. Even the 20% improvement from ibu is a help. (On a very personal note, I often have to combine that with half a Lortab to be able to keep pushing myself to do things. I can tolerate a pretty high level of pain 24/7 like most RA patients, but there is a limit to what I can tolerate & also force myself to keep moving without the pain distracting me too much.)
I just wanted to share that I took high doses of Ibuprofen for six years for chronic back pain before my RA diagnosis and it just about destroyed my stomach…Before that I had a VERY strong stomach…I had to switch to Tylenol and that helped my pain for several years without hurting my stomach…Now I take Methadone every day and I am extremely comfortable most of the time…How are patients supposed to protect their stomachs from high doses of Ibuprofen over an extended period of time such as when you suffer from RA?
Jewell
I don’t take my NSAID (meloxicam – in past taken Ibuprofen, oxaprozin and piroxicam) at the same as any tylenol. I wait a minimum of 2 hrs, preferrably 4 hrs before I take any tylenol. I’d always heard it was best to alternate dosing times if you had to take both. I wonder if it would’ve made a difference in that study. Also Ibuprofen has a short half life, and for me, the pain relief from that wears off too fast so I take the longer-acting NSAIDs. Sure glad my rheumy recommended those.
I go in for an injection of Orencia once a month, and I must tell you, it is my miracle drug. I has greatly improved my life. My joint pain is almost nil. My right index finger was beginning to “have a mind of its own” so to speak. It was crooked, and I could not pick up coins or other small objects and now the pain has subsided, and my index finger has straightened. I also no longer have toe or elbow pain! It is wonderful! What I am concerned about now is the fact that I signed up for long term health care and was denied because of my RA. I am only 55 and am very active! EVen though I am being pro-active with my RA, I was still denied. Is there anyone else there that has also been denied due to their RA and is there ANY insurance company who will insure an RA patient for long-term care?
I am very glad to hear stories about a treatment working. It gives the rest of us hope to hear it. The insurance questions are good ones – I heard it mentioned once or twice but have no data on it.