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Nuevos y mejor uso de los viejos medicam. para artritis
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Nuevos y mejor uso de los viejos medicam. para artritis

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Desde el año 2000, los pacientes con artritis reumatoide disponen de varios fármacos nuevos para tratar su enfermedad. Un estudio español evalúa por primera vez cómo ha cambiado el manejo de los pacientes en las consultas de reumatología en los últimos años, antes y después de la aparición de estas terapias más modernas.

La artritis reumatoide es una enfermedad autoinmune, causada por una combinación de factores genéticos y ambientales aún no conocidos del todo, y que afecta sobre todo a las mujeres (que representan el 70% de los pacientes) a partir de los 50 años. Las terapias disponibles se reparten entre los antiinflamatorios no esteroideos (que no frenan el avance de la enfermedad pero sí alivian los síntomas), los corticoides (qué sí modifican su curso pero suelen tener algunos efectos secundarios) y los llamados fármacos modificadores de la enfermedad (FARME).

En este último grupo conviven los antiguos fármacos (pequeñas moléculas como el tradicional metrotexato o la ciclosporina, capaces de modificar las cadenas de señalización que provocan la inflamación de las articulaciones propia de esta patología) con los más modernos tratamientos biológicos, diseñados específicamente para bloquear moléculas implicadas en la inflamación, como los que bloquean la citoquina TNF.

Muchos de ellos fueron aprobados precisamente en 2000, un año después de que comenzase el reclutamiento de pacientes para el trabajo que ahora acaba de publicarse en la revista 'Arthritis Research and Therapy'. "Hasta este estudio [bautizado como EMECAR] no teníamos ningún trabajo que nos dijese cómo era la artritis reumatoide en España", explica a el doctor Isidoro González-Álvaro, del Hospital Universitario de la Princesa de Madrid.
En total, han participado en la iniciativa 34 centros españoles que lo solicitaron y que incluyeron a 789 pacientes seleccionados al azar, con la idea de que fuesen lo más representativos posibles.

De los ensayos a la vida real
Durante los cuatro años que duró el seguimiento, alrededor del 30% de los pacientes recibieron una de las nuevas terapias (como la leflunomida o los antagonistas de TNF); que beneficiaron especialmente a los pacientes con una artritis más activa. Aunque eso sí, advierten, los resultados no fueron tan "espectaculares" como los vistos en los ensayos clínicos, donde los pacientes suelen ser más jóvenes y tienen mejores condiciones que en la vida real.

Sin embargo, como explica el doctor González-Álvaro, los que no recibieron los fármacos más modernos también mostraron cierta mejoría, gracias al manejo más eficiente de los fármacos tradicionales. Es probable, sugieren en el trabajo, que se deba a que los reumatólogos comenzaran a usar en este período herramientas objetivas para medir el estado de sus pacientes. Escalas como la llamada DAS 28, que hace un recuento del dolor y la inflamación en 28 articulaciones del cuerpo, y que ha permitido detectar a pacientes en peor estado de lo que podría suponerse previamente.

"Hemos aprendido a optimizar el uso de los fármacos viejos, como el metrotexato", destaca el reumatólogo de la Princesa, al tiempo que destaca algunas de las diferencias entre el manejo de la artritis en España y el resto de Europa. "Aquí, la flexibilidad del sistema sanitario español nos ha permitido proporcionar a nuestros pacientes medidas terapéuticas que el sistema de otros países impide, como el uso compasivo de algunas terapias antes de su aprobación oficial". elmundosalud
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