New Testing And Treatment Improves Outlook For Those With Rheumatoid Arthritis
Prevention and Treatment If you have been experiencing a prolonged period of pain, tenderness and stiffness around your joints, you should get to a doctor — and make it fast.
These are the symptoms of rheumatoid arthritis, a disease in which the immune system mistakenly attacks the body’s own tissues, and it is critical that you are treated for it right away. It could mean the difference between good health and joint damage severe enough to prevent you from carrying out your normal daily activities.
Specialists speak of a “window of opportunity,” the time period in which an aggressive regimen of drugs can stop the disease in its tracks.
“Patients should get treatment within the first three months,” says Dr. Kam Shojania, Director of the Division of Rheumatology at the University of British Columbia. “If we catch the disease at that time, we can stop its progression and the patient even has a shot at drug-free remission.”
Shojania says half of the patients who are diagnosed early enjoy drug-free remission but, he adds, that number drops when the diagnosis comes two years in. “Once enzymes have broken down the bone and cartilage of a joint, nothing can be done to repair it other than surgery,” adds Dr. Philip A. Baer, Chair of the Section of Rheumatology at the Ontario Medical Association. At that point, all drug treatment can do is control the disease to some extent, limiting further damage.
Novel new test helps with diagnosis
To diagnose the disease, physicians use blood tests that measure inflammation levels and look for biomarkers such as blood proteins associated with rheumatoid arthritis. An X-ray, ultrasound or magnetic resonance (MRI) imaging might also be used to detect joint damage.
In the past year, physicians have been able to use a new blood test, one that measures 14-3-3eta. It’s a protein that can activate inflammation in joints. Three Canadian doctors, Walter Maksymowych, Aziz Ghahary and Ruhangiz Kilani, discovered this protein’s role in rheumatoid arthritis.
This new blood test is a novel one that is highly specific to rheumatoid arthritis. The test has been shown to detect rheumatoid arthritis at an early stage in cases where more conventional tests did not. The new test contributes to a more accurate diagnosis of rheumatoid arthritis, particularly when combined with more conventional tests.
”Current diagnostic tests are limited in their ability to catch the disease early,” said Maksymowych, Medical Research Professor of Medicine and Rheumatologist at the University of Alberta. ”With this new test physicians now have the opportunity to treat rheumatoid arthritis early, prior to the onset of significant joint damage. This represents an important milestone towards the goal of personalized medicine.”
Specialists often treat rheumatoid arthritis patients with what they call “triple therapy,” a combination of three drugs including methotrexate, which is an older drug that is also used in the chemotherapy.
In recent years, specialists have increased the efficacy of established drugs by using them earlier and in higher doses. They have also started administering the drugs by injection rather than a tablet.
“There are now at least nine different biologics that can be used to treat rheumatoid arthritis,” says Baer. “I no longer run out of therapies in treating patients.”
Overall, treatment options have expanded dramatically in the past 15 years with the introduction of biologics. They are made from proteins produced by living cells instead of chemicals, and they work
by interacting with the immune system processes that cause inflammation. Biologics have proven very effective.
Of the 300,000 Canadians who have rheumatoid arthritis, fewer than ever are spending time in rehabilitation or acute care beds, says Shojania, and fewer need to see orthopedic surgeons.
“There are now at least nine different biologics that can be used to treat rheumatoid arthritis,” says Baer. “I no longer run out of therapies in treating patients.” He says there are more biologics on the way, and he describes the present day as “an exciting time in research.”
“People talk about a cure,” he continues. “I don’t think we’ll see that in the next five or ten years, but I anticipate being able to control rheumatoid arthritis to the extent that patients are able to live as though they don’t even have the disease.”