'A new lease of life' with early treatment for rheumatoid arthritis
Rheumatoid arthritis patient outcomes are dramatically better after the 'watch-and-wait' strategy is done away with
With most medical conditions, early treatment can make a world of difference.
In the case of rheumatoid arthritis, it can mean either disability or, in Dr Sheila Vasoo's words, "a new lease of life".
The most common form of autoimmune arthritis, rheumatoid arthritis occurs when the immune system becomes faulty.
Instead of protecting the body from foreign invaders, it begins to attack its own tissues, targeting the joint lining.
Common symptoms include pain, early morning stiffness and swelling in multiple joints like the small ones of the hands, wrists and feet.
At an advance stage, there may be fever, tiredness and weight loss as well, said the rheumatologist and senior consultant at The Arthritis & Rheumatology Clinic.
Patient education, addressing lifestyle factors including diet and exercise and stress management are highly important.Dr Sheila Vasoo
The attack does not stop at the joints. Other organs, like the eyes, lungs, heart and nerves, may be affected as well, said Dr Vasoo.
With damage occurring as early as within four to six months from the onset of the disease, early treatment is key.
Thanks to a paradigm shift in treatment strategy - from "watch and wait" to earlier diagnosis and treatment - rheumatoid arthritis patient outcomes have dramatically improved.
There are also more options for tailored therapies, with newer targeted therapies available on the market, she added.
A patient who had access to only limited treatment options some 20 years ago was wheelchair-bound and in constant pain.
The disease attacked her blood vessels and nerves - a complication known as rheumatoid vasculitis - and she was later referred to a hospice for terminal care, said Dr Vasoo.
Another patient with identical complications is now travelling again, thanks to the targeted rheumatoid arthritis treatment that brought the inflammation in her body under control over several months.
What happens when rheumatoid arthritis is left untreated?
If left untreated, not only will the joints be destroyed, leading to permanent disability and poor quality of life, extra-articular complications such as eye, lung, heart and nerve inflammation and damage may also occur.
Long-standing untreated or active inflammation can cause hardening of the arteries, leading to an increased risk of cardiovascular complications such as strokes or heart attacks.
Other organs such as the eyes, lungs, heart and nerves may be affected as well.
Who is more likely to get it?
Women, the elderly and those with a family history of rheumatoid arthritis are associated with an increased risk of getting the disease.
Smokers and ex-smokers are twice as likely to develop rheumatoid arthritis than non-smokers if they carry certain genes.
Smoking also increases the risk of other rheumatoid arthritis complications beyond the joints.
How do you treat the condition?
Therapy in rheumatoid arthritis must be holistic, and success in getting well requires a strong partnership between the patient and the rheumatologist.
Patient education, addressing lifestyle factors including diet and exercise and stress management, are highly important.
Medications known as disease-modifying anti-rheumatic drugs (DMARDs) are the cornerstone of rheumatoid arthritis treatment.
Studies have shown that DMARDs significantly reduce disease progression, delay joint damage and prevent other complications like early death.
Conventional DMARDs work but more slowly such as methotrexate, an anchor drug in rheumatoid arthritis.
When patients fail to respond or cannot tolerate conventional drugs, newer targeted drugs like biologics such as anti-TNF agents and small-molecule JAK inhibitors such as Xeljanz may be considered.
Anti-TNF injections neutralise one of the immune system's signals that lead to inflammation and joint damage, while oral JAK inhibitors work within the cells to reduce inflammatory signals involved in rheumatoid arthritis.
These newer targeted agents have been shown to be effective in reducing symptoms more quickly and also delaying or stopping disease progression.