Simponi Aria for Rheumatoid Arthritis
Dr. Jeffrey Landis, February 2019
Rheumatoid arthritis is an autoimmune disease that not only affects the joints, but other organ systems, as well. Rheumatoid arthritis will classically involve the joints of the hands (MCP’s, PIP’s, and wrists). It can and will involve other joints of the body, but it will not affect the DIP’s or the spine, except for the neck. Rheumatoid arthritis presents with pain and swelling in the affected joints. In the morning, the joints will generally be stiff for longer than an hour. If rheumatoid arthritis is left untreated, erosions around the joints will form. Untreated rheumatoid arthritis will lead to permanent deformity of the joints.
Rheumatoid arthritis will also affect other organs like the lungs, heart, and eyes. 20% of rheumatoid arthritis patients will develop scarring of the bases of the lungs. Patients generally do not have any symptoms of the lung scarring. They can also develop fluid around the lungs and heart, but it usually does not cause any symptoms either. The chronic inflammation from rheumatoid arthritis leads to coronary heart disease that leads to heart attack. Rheumatoid arthritis is as big of a risk factor for heart disease as diabetes. Rheumatoid arthritis will also cause inflammation in the eyes. If the sclera (whites of the eyes) is involved, it can thin out and lead to rupture of the eye itself.
Initial rheumatoid arthritis treatment is with methotrexate, unless contraindicated. If methotrexate is not tolerated or not completely effective, Simponi Aria is a good medication to try next. Simponi Aria is a TNF - ⍺ inhibitor. It reduces the inflammation in the joints by inhibiting a single cell messaging molecule. Studies have shown that it not only halts the inflammatory response leading to improved pain and swelling of the joints, but it also stops the erosive and deforming process of the rheumatoid arthritis.
Simponi Aria is administered by infusion. The infusion takes about 30 minutes and is given every 2 months at the regular doctor’s office visit. It is recommended that no live vaccines be given while on this medication. Pneumonia vaccinations are recommended. Side effects can include increased risk of infections due to immunosuppression, malignancy, and PML. The most common adverse reactions (incidence ≥3%) are: upper respiratory tract infection, viral infection, bronchitis, hypertension, and rash. Simponi Aria cannot be used in Multiple Sclerosis, as it will worsen this condition. Simponi Aria can also worsen heart failure.
Simponi Aria is safe to use during pregnancy. There is an increased risk of low white blood counts and immunosuppression in newborns to mothers on Simponi Aria, so it is used with caution. To reduce this risk, the Simponi Aria is sometimes stopped by week 32. It is restarted post-partum, as it is safe to use while breast feeding.