Living with Rheumatoid Arthritis
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Transcript of Living with Rheumatoid Arthritis
Living with Rheumatoid Arthritis
Presented by:
Lauren Kennish, MD
Rheumatology
January 15, 2014
Lecture Outline
• What is Rheumatoid Arthritis (RA)?
• How is it diagnosed?
• What are the symptoms of RA?
• What are the treatment options?
• How do we live well with RA?
• What is new on the horizon?
What is Rheumatoid Arthritis?• RA is an autoimmune disease
• Autoimmune disease:Immune system incorrectly targets your own
tissues and organs
Antibodies form and attack cells
Inflammation/Swelling
Damage/Disease
What is Rheumatoid Arthritis?• Type of inflammatory arthritis = pain,
swelling and stiffness in the joints
• Systemic – can affect whole body
• Chronic condition
• Can damage cartilage,
bone• Mild Severe
Arthritis.org, 12/2013
flare relapse
remission
What is RA?
• Prevalence: 1.5 million people (0.6% population)
• Diagnosis age: Average
30-60 years old
• Females (3x) > Males
Helmick et al. A&R, 2008.
What Causes RA?
• Largely unknown• Theories:
Genetics +
Environment
• Possible Triggers Infection
• Gut/Gum bacteria Smoking Obesity Stress Female hormones
How is RA Diagnosed?
• History and Symptoms
• Blood tests Rheumatoid factor, anti-CCP, anti-MCV Inflammatory markers – ESR, CRP
How is RA Diagnosed?
• Imaging Xray MRI Ultrasound
What are the Symptoms of RA?
• Joint pain and swelling Small joints, symmetric
• Morning stiffness > 1 hour
• Difficulty with activities
• Joint DamageArthritis.org, 12/2013
What are the Symptoms of RA?
• Fatigue
• Anemia
• Skin nodules
• Inflammation – Eyes Blood vessels Lungs Heart
Associated Autoimmune Diseases
• Sjogren’s Syndrome
• Hashimoto’s Thyroiditis (Hypothyroidism)
Associated Conditions• Osteoarthritis
• FibromyalgiaWebmd.com, 2013
Associated Conditions• Osteoporosis
• Heart Disease Atherosclerosis -> high cholesterol, heart attack
• Increased risk of: Infections Cancer
Related Types of Arthritis
• Spondyloarthritis Psoriatic Arthritis Ankylosing Spondylitis Reactive Arthritis
How is RA Treated?
• There is no cure yet
• BUT…
• Many treatment options to decrease symptoms and associated conditions
• Can lead active, healthy lives
How is RA Treated?• Goal:
Reduce symptoms Maintain remission Prevent flares Prevent complications Prevent joint damage Prevent disability Maintain quality of life
• Treatment is tailored to individual Based on symptoms, concurrent conditions, lifestyle Treatment is usually continuous Combination of medication and non-medical therapy
• EARLY treatment is KEY to successful course
How is RA Treated?
• Over-the-counter or prescription
• Treats: Temporary relief of pain
and stiffness
• Side effects: Stomach ulcers, kidney/liver problems,
high blood pressure, heart disease
NSAIDs: Non-Steroidal Anti-Inflammatory Drugs
How is RA Treated?
• Suppresses immune system cells from forming and making antibodies to tissues
• Modifies disease
• Slow acting
• Oral, Injection
• Requires close monitoring
Immunosuppressive Therapy
How is RA Treated?
• Anti-inflammatory / Immune suppressing• Works rapidly• Oral or injection• Treats:
Joint pain Swelling
• Potential side effects: Weight gain, mood change, infections,
diabetes, high blood pressure, osteoporosis, cataracts
Steroids / Prednisone
How is RA Treated?
• Widely used, first-line medications
• Methotrexate• Leflunomide (Arava)• Sulfasalazine• Hydroxychloroquine (Plaquenil)
Disease Modifying Anti-Rheumatic Drugs
How is RA Treated?
• Treat: Joint pain Swelling, stiffness Reduces risk of progression and joint damage Prevents flares
• Potential side effects: Stomach upset, infection, hair loss, oral ulcers,
rash, low blood counts, inflammation of liver or lungs, vision problems
DMARDs
How is RA Treated?
• Second line therapies for more severe symptoms
• Have revolutionized treatment• Injectable or oral (new)• Mechanism of action
Bind to cells/molecules to stop inflammation, autoimmune signaling
• Potential side effects: Infection, rash, allergy, low blood counts, heart
failure, neurologic condition, skin cancer
Biologics
How is RA Treated?
• TNF inhibitors: Etanercept (Enbrel) Adalimumab (Humira) Infliximab (Remicade) Certolizumab (Cimzia) Golimumab (Simponi)
• Abatacept (Orencia)• Tocilizumab (Actemra)
Biologics
• Rituximab (Rituxan)• Tofacitinib (Xeljanz)
Nature.com, 2013
How is RA Treated?
• Arthrocentesis = joint injections Steroids Hyaluronic Acid
• Surgery: Joint replacement Joint fusion Tendon repair
Interventional Treatment
How is RA Treated?
• Exercise Low-moderate activities Stretching, strengthening Yoga, Pilates, Tai Chi
• Physical Therapy
• Bracing
• Acupuncture
Additional Treatment
How to Live Well with RA?
• How to: Maintain control of disease to prevent flares Avoid complications and associated risks Cope with the disease Feel healthy
• To lead an active, high quality life
How to Live Well with RA?
Follow-up with Rheumatologist Regularly:
• 2-6 months for monitoring
• Even if feeling well
• Recognize symptoms of flares
• Get treated early
• Take medications consistently
Follow-up with Your Doctors:
• Follow regularly for preventative care Internist/Primary care
• Follow with Specialists Ophthalmologist, Orthopedist, Cardiologist
• Planned surgery Best when low activity
How to Live Well with RA?
How to Live Well with RA?
Reduce Risk of Infections:
• Increased risk of infection
• Up to date with vaccines Influenza, Pneumonia, Shingles
• Wash hands frequently
• Stay away from people who are sick
• Get evaluated sooner rather than later
How to Live Well with RA?
Healthy lifestyle:
• Exercise
• Modify activities
• Don’t smoke
How to Live Well with RA?
Healthy Lifestyle:
• Manage fatigue Get enough sleep Rest during the day Plan your time effectively Medications
• Treat depression Reduce stress Social support
Arthritis.org.
How to Live Well with RA?
Healthy Lifestyle:• Eat well balanced diet• Weight loss • Vitamin D, Calcium• Omega-3 fatty acids• ? Avoid certain foods
• Alternative treatments/supplements – not well studied
How to Live Well with RA?
Planned Pregnancy:
• Ideally when in remission
• Many medications have to be stopped before pregnancy
• Usually symptoms improve during pregnancy
What’s New with RA?
• Tofacitinib (Xeljanz) Similar to biologics in effectiveness and side effects Targets inflammation pathway But, it’s oral
• Vectra-DA test for RA activity
• In development…
What’s New with RA?
• 65+ new medications in development for RA!
What’s New with RA?
• Ongoing research: Why RA develops Genetics of RA Biomarkers to better diagnose and predict
response to medication
For More Information
• Arthritis Foundation
• National Institute of Arthritis and Musculoskeletal and Skin Diseases
www.niams.nih.gov
• American College of Rheumatology www.rheumatology.org
Questions?Thank you!
Lauren Kennish, MD
Summit Medical Group
Rheumatology
908-273-4300
www.summitmedicalgroup.com
Facebook/SummitMedicalNJ
Twitter: @SummitMedicalNJ