understanding rheumatoid arthritis randall j. reed, md friday, november 13, 2015 11:00 a.m. est
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Understanding Understanding Rheumatoid ArthritisRheumatoid Arthritis
Randall J. Reed, MD
Friday, November 13, 201511:00 a.m. EST
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AgrAbility: USDA-sponsored program that assists farmers, ranchers, and other agricultural workers with disabilities.– Partners land grant universities with disability
services organizations. Currently 20 state projects– National AgrAbility Project: Led by Purdue’s Breaking
New Ground Resource Center. Partners include: Goodwill of the Finger Lakes The Arthritis Foundation, Heartland Region University of Illinois at Urbana-Champaign Colorado State University
– More information available at www.agrability.org
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Understanding Rheumatoid Understanding Rheumatoid ArthritisArthritis
Randall J. Reed, MD
Rheumatology Associates, PC
Indianapolis, Indiana
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ArthritisArthritis
66 million people with arthritis in America2nd only to heart disease in disabilityCosts US $86.2 billionMore common in women than menLimits everyday activities for 7 million
Americans
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Types of ArthritisTypes of Arthritis
Over 100 different types of arthritis Osteoarthritis Rheumatoid Arthritis Gout Psoriatic Arthritis Systemic Lupus Erythematosus Septic Arthritis Lyme Disease Ankylosing Spondylitis CPPD Deposition Disease Temporal Arteritis/Polymyalgia Rheumatica
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Rheumatoid Arthritis (RA)Rheumatoid Arthritis (RA)
Around 2 million people in the USMore common in women than menCan occur at any age, onset usually in 3rd to
5th decades of lifeChronic, inflammatory disease that
primarily involves jointsRheumatoid arthritis can also affect the
skin, saliva glands, eyes, lungs, and heart
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Inflammatory versus Inflammatory versus degenerative arthritisdegenerative arthritis
www.vics.com
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What’s happening in RA?What’s happening in RA?
Immune system attacks proteins in joints
Thickening of synovium
Influx of immune cells into joint
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Why do people get RA?Why do people get RA?
Genetic predisposition– Family History – Certain Ethnic populations– Genetic marker HLA-DR4
Environmental exposures?– Viruses– Bacteria– Food allergies?
Role of Hormones Immune System
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Symptoms of RASymptoms of RA Pain and swelling of joints,
usually symmetrical pattern Morning stiffness lasting
longer than 1 hour Nodules underneath the skin Joint deformity Non-joint symptoms
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Joint SwellingJoint Swelling
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Joint DeformityJoint Deformity
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Nodules of RANodules of RA
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How is RA diagnosed?How is RA diagnosed?
Clinical History and ExamBlood tests
– Rheumatoid Factor– Anti-CCP antibody
X-raysMRI
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X-ray imageX-ray image
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MRI Image of RAMRI Image of RA
From Bocaradiology.com
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What should I expect with RA?What should I expect with RA?
A chronic illness, only 5-10% remission rate
Untreated, 90-95% of patients will have bone damage, usually within first 2 years
5-10% of RA patients become disabled every year (old data)
Associated with increased risk of infections, heart disease, and lymphoma
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What’s the good news?!What’s the good news?!
Advancements in diagnosis– CCP antibody– MRI and Ultrasound
Better treatments!Advancing Research
– Stem cell– Genetic based therapies– Individualized therapies
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Goals of therapy for RAGoals of therapy for RA
Reduce joint pain and swelling Improve Function Prevent erosions and joint deformity Minimize risk of adverse events from medications
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How is RA treatedHow is RA treated
Most patients will require a “disease modifying anti-rheumatic drug”, or DMARD
Corticosteroids, i.e. prednisoneNon-steroidal anti-inflammatory drugs
(NSAIDS) / COX-2 inhibitorsJoint injectionsBiological Response Modifiers
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DDisease isease MModifying odifying AAnti-nti-RRheumatic heumatic DDrugs (DMARDS)rugs (DMARDS)
Methotrexate (Trexall) Sulfasalazine (Azulfidine) Hydroxychloroquine (Plaquenil) Leuflonomide (Arava)
Azathioprine (Imuran) Cyclosporine (Neoral) Minocycline (Minocin) Gold (Auranofin)
First Line Therapy
Second Line Therapy
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Biological therapyBiological therapy Biologics - drugs derived from living
organisms that are designed to either inhibit or supplement a specific component of the immune system
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Biologic Response ModifiersBiologic Response Modifiers
Tumor necrosis factor Inhibitors- “Anti-TNF therapy”– Humira (Adalimumab)– Enbrel (Etanercept)– Remicade (Infliximab)– Cimzia (certolizumab pegol)– Simponi (golimumab)
Kineret (Anikinra) Orencia (Abatacept) Rituxan (Rituximab) Actemra (tocilizumab)
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Abbvie StudyAbbvie StudyFigure 1: ACR 20 Responses over 52 Weeks
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Anti-TNF medicines have Anti-TNF medicines have revolutionized treatment for RArevolutionized treatment for RA
"The PREMIER data are encouraging because they suggest that early and aggressive treatment may slow or inhibit patients' joint damage," said Ferdinand Breedveld, M.D., professor, Department of Rheumatology, University of Leiden, Leiden, Netherlands –from Arthritis News June 9th 2005.
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Risks of therapyRisks of therapy
All treatments will carry some risk!Not treating RA also carries a riskAsk doctor about increased risk of
infection, potential liver toxicity, stomach upset, interactions with other medicines; recent press about increased cancer risk
Many of the medications require chronic laboratory monitoring
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Diet and ArthritisDiet and Arthritis
Weight lossAnti-oxidants?Vitamin CSupplements
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Exercise and arthritisExercise and arthritis
Water AerobicsWalkingPhysical TherapyYoga
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Surgery for Surgery for RARA
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SummarySummary
• Rheumatoid arthritis is a chronic inflammatory disease that affects joints in a symmetrical pattern; usually hands, wrists and feet become involved
• Left untreated, RA typically leads to joint damage and disability
• Medical treatment for RA can halt disease progression and has improved quality of life for patients