title: Current and emerging therapies for rheumatoid arthritis, with a focus on infliximab: clinical impact on joint damage and cost of care in canada.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is a physically debilitating disease that places an enormous burden not only on individuals and their families but also on the economy. Affecting -1% of the Canadian population, RA is characterized by pain and swelling of joints. Without effective treatment, RA results in joint destruction that often requires surgery.
  
  
  OBJECTIVE
  This review summarizes the effect of current and new RA treatments on joint damage, with a focus on infliximab. The health-economic repercussions and potential impact of arresting the joint destruction of RA are discussed.
  
  
  METHODS
  Information for inclusion in this review was identified through searches of the MEDLINE and HealthStar databases from 1995 to 2000. Search terms included rheumatoid arthritis, treatment guidelines, economics, and individual drug names.
  
  
  RESULTS
  Standard initial RA drug therapy has been aimed at reducing pain and inflammation, whereas use of the more potent disease-modifying antirheumatic drugs (DMARDs) has been reserved for later stages of disease. More aggressive RA treatment involves introducing DMARDs at the earliest stage. The largest single direct cost of RA involves hospital admissions for the correction of joint deformities. Among newer therapies, the anti-tumor necrosis factor-alpha agent infliximab has been shown to arrest radiographic measures of disease progression.
  
  
  CONCLUSIONS
  With early and aggressive treatment involving new drugs and drug combinations, it may be possible to ameliorate the physical, social, and economic effects of RA.
authors.affiliation: Department of Medicine, University of Alberta Hospital Site, Heritage Medical Research Centre, Edmonton, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Russell
authors.forename: B
authors.initials: B
authors.lastname: Haraoui
authors.forename: E
authors.initials: E
authors.lastname: Keystone
authors.forename: A
authors.initials: A
authors.lastname: Klinkhoff
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics*; D002170:Canada; D005260:Female; D006801:Humans; D000069285:Infliximab; D016916:Joint Deformities, Acquired / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000069285:Infliximab