"Early Diagnosis and Treatment of RA: A Therapeutic Window of Opportunity" FAQs

Presented for The Annual Chickie Goldstein Memorial Lecture, Public and Patient Education Department Program, September 13, 2005

Stephen A. Paget, MD, FACP, FACR
Stephen A. Paget, MD, FACP, FACR

Physician-in-Chief, Chairman of the Division of Rheumatology, Hospital for Special Surgery

Joseph P. Routh Professor of Medicine, Weill Cornell Medical College

What are the symptoms of RA?

Symptoms of RA can be similar to other inflammatory diseases. For that reason, it is important to seek definitive diagnosis early on to ensure appropriate treatment. Symptoms include swollen, painful, warm joints, often in the hands (knuckles, mid-finger joints) and wrists. This inflammation is symmetrical; that is, both sides of the body are involved. Morning stiffness lasting longer than 1 hour and marked fatigue/malaise are often present. Unexplained fever is also sometimes an accompanying symptom.

I’m currently on Methotrexate and seem to be doing well. Should I consider speaking to my doctor about adding a biologic like Enbrel or Humira?

That depends on what you consider “doing well.” How is your feeling of well-being measured? Similar to the way we view therapeutic goals for other chronic illnesses like diabetes, we should view our goals for treatment for RA using tightly controlled measures. Our goal for treatment is to achieve “no evidence of disease,” a term borrowed from cancer treatment.

In treatment of RA, we look to achieve normal functioning - no signs of redness, warmth, swelling, or tenderness. In order to prevent joint erosion, we treat RA aggressively to try to achieve this goal. Current research indicates that using one or more disease-modifying drugs with NSAIDs, or in combination with a biologic early on, can yield excellent results. Ultimately, you and your rheumatologist should look at your current treatment plan and determine if it is working for you.

Is there anything one can do, using diet, vitamins, exercise, etc., to prevent RA?

Certainly, a well-balanced diet and daily exercise are important to overall health. To date, there is no known method of preventing RA. What we do know is that there is a therapeutic window of opportunity to prevent extensive joint damage and halt the progress of the disease once it’s diagnosed. The most important issue is early diagnosis. Consulting with a rheumatologist - a specialist in the diagnosis and treatment of RA - is the first, most important step. Appropriate, early intervention is the best method we know of to prevent onset of the severe damage this disease can cause.

Do I need to take a disease modifying drug if my inflammation seems under control with NSAIDs? I’m worried about the side-effects of these drugs.

Only you and your rheumatologist can determine the proper course of treatment based on “the personality” of your RA. It is important to note, however, that nonsteroidal anti-inflammatory drugs (NSAIDs) only address inflammation - they do not halt disease progression and joint damage. In making medication recommendations, your rheumatologist will carefully consider your medical history and drug allergies to minimize the risks of side-effects and reactions. Further, while on disease-modifying antirheumatic drugs (DMARDs), patients are closely followed to determine if the medication is working effectively and if there are any reactions or side-effects.


Learn about the Living with RA Workshop at HSS

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