http://www.clevelandclinic.org/healthextra/default.asp?index=9346
When Debbie S.* started taking karate five years ago, she pushed herself hard through the debilitating pain of rheumatoid arthritis. When she earned her black belt a year ago, she did it pain-free.
"I never thought I would get my black belt," she says. "It is a five-hour test, and I was sure I could not endure the pain."
For Debbie, the difference between then and now is a drug called Enbrel, prescribed by her doctor, Leonard Calabrese, D.O., vice chairman of the Department of Rheumatic and Immunologic Diseases at The Cleveland Clinic.
The first sign that Enbrel was working occurred when Debbie got out of bed one morning. Because of the pain she experienced in her feet, she says she had to mentally work up the nerve to put both feet on the floor each morning upon arising. But within one month, Enbrel changed all that.
Her next clue of the drug’s effectiveness was through her beloved karate. "My potential went through the ceiling. I was able to kick higher and do all the moves without collapsing in pain. I attribute this entirely to the drug I am taking now," she says. Dr. Calabrese is as excited about Debbie’s remarkable progress as she is.
"It has made a big difference in her quality of life," he says. "She had active arthritis involving most of the joints in her body. Now, she has minimal symptoms of the disease."
Enbrel belongs to a family of drugs that promises relief for other patients with immune system disorders, Dr. Calabrese explains. "It is part of a new revolution in the treatment of serious forms of inflammatory arthritis, a brand of drugs known as biologic therapies developed through molecular, DNA technology. This drug, in particular, has been targeted to neutralize a very critical inflammatory mediator of arthritis, the tumor necrosis factor, or TNF."
In the fall of 1999, the Food and Drug Administration approved Enbrel. "It is the biggest breakthrough in the treatment of this disease since total hip replacement," Dr. Calabrese says. "It offers many people not only a dramatic improvement in their symptoms, but in their quality of life."
Debbie receives two injections of Enbrel per week. Currently, most insurance plans cover the cost of the drug for patients with severe arthritis. But Dr. Calabrese is hopeful that eventually insurance will cover the cost for people with milder cases since the drug inhibits the progression of arthritis.
"The drug retards the destruction of bones," he says. "It stops it cold. We hope to give it to patients with early arthritis to forestall disability, loss of income and the need for total joint replacement 10 or 12 years from now. We believe that giving it to these patients will prove to be cost-effective."
The DNA origin of the drug is what makes it effective, Dr. Calabrese explains, noting that one of the best aspects of the medication is its lack of adverse side effects. "Prior therapies suppressed the immune system and, by comparison, were very crude."
No one knows the cause of rheumatoid arthritis, which is immunologically based. Physicians believe it may be partly genetic and partly environmental. About 2 to 3 million people nationwide have rheumatoid arthritis, which causes chronic health problems and shortens life expectancy.
Dr. Calabrese believes that Debbie should be able to remain on Enbrel indefinitely because research does not suggest that the drug stops working. A few hundred other rheumatoid arthritis patients at The Cleveland Clinic also are using Enbrel, and he estimates that about 75 percent of them "are doing dramatically well." For those who are not responding to the drug, more aggressive therapy with traditional methods and experimental drugs are being tried, he says. Research also continues into developing more specific biologic drugs for different parts of the immune system.
[ Please go to the above website for more information.]