living with rheumatoid arthritis
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An autoimmune disorder that inflames the lining of joints, rheumatoid arthritis (RA) affects more women than men. Join us for an overview of rheumatoid arthritis and other forms of arthritis, including symptoms and diagnosis as well as treatment and management strategies that can help you.TRANSCRIPT
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