Rheumatoid Arthritis Drugs Have Same Impact on Time Lost at Work: Study

Patients gained no more benefit from higher-priced biologic drug Remicade vs. cheaper medications

By Robert Preidt

HealthDay Reporter

MONDAY, July 1 (HealthDay News) -- Treatment with a pricey biological drug was no better than cheaper, conventional therapy in terms of reducing time off from work for people with rheumatoid arthritis, a new study finds.

Swedish researchers assessed lost work days among rheumatoid arthritis patients who had not responded to initial treatment with a standard medication, methotrexate.

The group of 204 patients were randomly given either the biological drug infliximab (Remicade) or conventional combination therapy with the non-biologics sulfasalazine plus hydroxychloroquine.

At the start of the study, the average amount of lost work time was 17 days per month for all patients. During the 21-month study, the patients receiving conventional therapy lost about six fewer days of work per month, compared with about five fewer days for those taking Remicade -- not a significant difference.

Regardless of the drugs used, early and aggressive treatment for patients who've failed to respond to methotrexate "not only stops the trend of increasing work loss days but partly reverses it," concluded researchers led by Jonas Eriksson of the Karolinska Institute in Stockholm.

However, the team say they "did not find any difference" in terms of work absentee rates depending on which drugs the patients took, even though Remicade did seem to provide "significantly improved disease control."

Experts not connected to the study said the relative price tags of these drugs is another key factor to consider.

"Currently, there are nine biologics FDA-approved for the treatment of rheumatoid arthritis," explained Dr. Steven Carsons, chief of the division of rheumatology, clinical immunology and allergy at Winthrop-University Hospital in Mineola, N.Y.

However, he said that biologics can cost between $15,000 to $20,000 per year, while the two non-biologics included in the Swedish study might cost only a tenth of that amount.

So, the new findings are "reassuring in terms of having effective, lower-cost alternatives with established safety profiles available for patients who do not have coverage for the more expensive biologics," Carsons said.

He added, however, that in the "real world" each patient responds differently to various rheumatoid arthritis medications, and many do fare much better on a biologic drug.

Another rheumatologist, Dr Diane Horowitz of North Shore University Hospital in Manhasset, N.Y., said the new study "brings into question the utility of choosing the more expensive [treatment] option" if ability to function well at work is a key consideration.

It's not clear, however, if the work-related benefits of a biologic would improve over a longer period of use. According to Horowitz, who is also a rheumatologist at Long Island Jewish Medical Center in New Hyde Park, N.Y., "further reseach needs to be done" to answer that question.

The study was published July 1 in the journal JAMA Internal Medicine.

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The Financial Impact of Sports Injuries

Playing sports is good for you in many ways. It's a great way to be active, connect with friends, ease stress, and enjoy your free time.

Still, injuries can happen.

If you've had a sports injury, here are five ways to minimize the impact on your wallet.

Have you had a doctor check out your injury? That's the first step to let you find out:

How serious the injury isWhat the recovery will be likeAny limitations you'll have while you heal

The more you know, the easier it will be to make financial plans. And talking with your doctor is important if you intend to apply for disability assistance.

If your doctor prescribes physical therapy for your injury, go. The rehab will help you recover.

Some health insurance plans limit payments for rehabilitation. So check with your carrier to see what your policy offers.

If you'll be sidelined for a short time, you may be able to negotiate a leave of absence from work. That way you'll collect all or part of your paycheck.

Depending on what kind of work you do, you may be able to take on other responsibilities while you recover from your injury. Or you may be able to work from home. The human resources manager at your job can let you know about your options.

If you may be out of work for several months or longer, check on options for disability assistance.

Group or private disability insurance. Some employers offer disability insurance plans for all employees. Ask your human resources manager if you have it. Keep in mind that you can't get disability insurance for an injury that has already happened.

You may also be able to get benefits from a private disability insurance policy.

"Private disability insurance plans typically pay all or most of your pre-disability income for the first year or two if you cannot perform the duties of the job you held before becoming disabled," says Nancy G. Shor, an expert in disability coverage. Shor is executive director of the National Organization of Social Security Claimants' Representatives.  "After two years, many policies continue paying only if you are unable to do any kind of work."

State disability assistance. Some states offer their own disability insurance plans. Requirements vary widely. Contact your state's department of employment for information.

Social Security disability. Social Security offers disability benefits. You may qualify if you are unable to do the work you were doing before your injury. You may also qualify if you can't do any other kind of work because of physical or mental impairment.    

Medicare. If you are disabled and unable to work for more than two years, you qualify for Medicare. That's the case even if you are below retirement age.

Medicare can be particularly helpful if your disability involves ongoing medical costs.

Workers' compensation. Most sports injuries aren't covered by workers' compensation, which is typically limited to injuries on the job. There are exceptions, however. You may be covered if you're injured during an activity sponsored by your employer. And you might also be covered if the injury happened during an activity that your employer specifically encouraged you to do.

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