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.

1. Living with Rheumatoid Arthritis
Presented by:
Lauren Kennish, MD
Rheumatology
January 15, 2014

2. Lecture Outline
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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?

3. 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

4. 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
flare
Severe
relapse
remission
Arthritis.org, 12/2013

5. 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.

6. What Causes RA?
• Largely unknown
• Theories:
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Genetics
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Environment
• Possible Triggers
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Infection
• Gut/Gum bacteria
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Smoking
Obesity
Stress
Female hormones

7. How is RA Diagnosed?
• History and Symptoms
• Blood tests
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Rheumatoid factor, anti-CCP, anti-MCV
Inflammatory markers – ESR, CRP

8. How is RA Diagnosed?
• Imaging
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Xray
MRI
Ultrasound

9. What are the Symptoms of RA?
• Joint pain and swelling
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Small joints, symmetric
• Morning stiffness
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> 1 hour
• Difficulty with activities
• Joint Damage
Arthritis.org, 12/2013

10. What are the Symptoms of RA?
• Fatigue
• Anemia
• Skin nodules
• Inflammation –
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Eyes
Blood vessels
Lungs
Heart

11. Associated Autoimmune Diseases
• Sjogren’s Syndrome
• Hashimoto’s Thyroiditis (Hypothyroidism)

12. Associated Conditions
• Osteoarthritis
Webmd.com, 2013
• Fibromyalgia

13. Associated Conditions
• Osteoporosis
• Heart Disease
Atherosclerosis -> high
cholesterol, heart attack
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• Increased risk of:
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Infections
Cancer

14. Related Types of Arthritis
• Spondyloarthritis
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Psoriatic Arthritis
Ankylosing Spondylitis
Reactive Arthritis

15. How is RA Treated?
• There is no cure yet
• BUT…
• Many treatment options to decrease
symptoms and associated conditions
• Can lead active, healthy lives

16. How is RA Treated?
• Goal:
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Reduce symptoms
Maintain remission
Prevent flares
Prevent complications
Prevent joint damage
Prevent disability
Maintain quality of life
• Treatment is tailored to individual
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Based on symptoms, concurrent conditions, lifestyle
Treatment is usually continuous
Combination of medication and non-medical therapy
• EARLY treatment is KEY to successful course

17. How is RA Treated?
NSAIDs: Non-Steroidal Anti-Inflammatory Drugs
• Over-the-counter or prescription
• Treats:
Temporary relief of pain
and stiffness
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• Side effects:
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Stomach ulcers, kidney/liver problems,
high blood pressure, heart disease

18. How is RA Treated?
Immunosuppressive Therapy
• Suppresses immune system cells from
forming and making antibodies to
tissues
• Modifies disease
• Slow acting
• Oral, Injection
• Requires close monitoring

19. How is RA Treated?
Steroids / Prednisone
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Anti-inflammatory / Immune suppressing
Works rapidly
Oral or injection
Treats:
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Joint pain
Swelling
• Potential side effects:
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Weight gain, mood change, infections,
diabetes, high blood pressure, osteoporosis,
cataracts

20. How is RA Treated?
Disease Modifying Anti-Rheumatic Drugs
• Widely used, first-line medications
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Methotrexate
Leflunomide (Arava)
Sulfasalazine
Hydroxychloroquine (Plaquenil)

21. How is RA Treated?
DMARDs
• Treat:
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Joint pain
Swelling, stiffness
Reduces risk of progression and joint damage
Prevents flares
• Potential side effects:
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Stomach upset, infection, hair loss, oral ulcers,
rash, low blood counts, inflammation of liver or
lungs, vision problems

22. How is RA Treated?
Biologics
• 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
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• Potential side effects:
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Infection, rash, allergy, low blood counts, heart
failure, neurologic condition, skin cancer

23. How is RA Treated?
Biologics
• TNF inhibitors:
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Etanercept (Enbrel)
Adalimumab (Humira)
Infliximab (Remicade)
Certolizumab (Cimzia)
Golimumab (Simponi)
• Abatacept (Orencia)
• Rituximab (Rituxan)
• Tocilizumab (Actemra) • Tofacitinib (Xeljanz)
Nature.com, 2013

24. How is RA Treated?
Interventional Treatment
• Arthrocentesis = joint injections
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Steroids
Hyaluronic Acid
• Surgery:
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Joint replacement
Joint fusion
Tendon repair

25. How is RA Treated?
Additional Treatment
• Exercise
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Low-moderate activities
Stretching, strengthening
Yoga, Pilates, Tai Chi
• Physical Therapy
• Bracing
• Acupuncture

26. How to Live Well with RA?
• How to:
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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

27. 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

28. How to Live Well with RA?
Follow-up with Your Doctors:
• Follow regularly for preventative care
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Internist/Primary care
• Follow with Specialists
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Ophthalmologist, Orthopedist, Cardiologist
• Planned surgery
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Best when low activity

29. How to Live Well with RA?
Reduce Risk of Infections:
• Increased risk of infection
• Up to date with vaccines
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Influenza, Pneumonia, Shingles
• Wash hands frequently
• Stay away from people who are sick
• Get evaluated sooner rather than later

30. How to Live Well with RA?
Healthy lifestyle:
• Exercise
• Modify activities
• Don’t smoke

31. How to Live Well with RA?
Healthy Lifestyle:
• Manage fatigue
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Get enough sleep
Rest during the day
Plan your time effectively
Medications
• Treat depression
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Reduce stress
Social support
Arthritis.org.

32. 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

33. 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

34. What’s New with RA?
• Tofacitinib (Xeljanz)
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Similar to biologics in effectiveness and side
effects
Targets inflammation pathway
But, it’s oral
• Vectra-DA test for RA activity
• In development…

35. What’s New with RA?
• 65+ new medications in development for RA!

36. What’s New with RA?
• Ongoing research:
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Why RA develops
Genetics of RA
Biomarkers to better diagnose and predict
response to medication

37. For More Information
• Arthritis Foundation
• National Institute of Arthritis and
Musculoskeletal and Skin Diseases
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www.niams.nih.gov
• American College of Rheumatology
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www.rheumatology.org

38. Questions?
Thank you!
Lauren Kennish, MD
Summit Medical Group
Rheumatology
908-273-4300
www.summitmedicalgroup.com
Facebook/SummitMedicalNJ
Twitter: @SummitMedicalNJ