Patient Care and Education
Inflammatory Arthritis is a serious and systemic disease that includes many subtypes. These diseases predominantly affect the joints, but can also involve other parts of the body including the heart, lungs, eyes and skin. Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting an estimated 2 million people in the United States. However, there are many different kinds of inflammatory arthritis that affect millions more individuals every year.
Most forms of inflammatory arthritis are progressive and, if left untreated, will result in pain, disability, and serious damage to the joints. However, rheumatologists (the physicians who specialize in the care of people with inflammatory arthritis) have more treatments available than ever before to help those diagnosed cope with symptoms and maintain their quality of life. It’s important for those who have been diagnosed to know that a growing body of research shows that treatment is most effective when it begins early in the course of the disease.
The rheumatologists and other staff at the Inflammatory Arthritis Center at Hospital for Special Surgery use a combination of nonsurgical techniques, including medications to relieve swelling and pain, while regulating the immune symptom. For many people with inflammatory arthritis, these treatments successfully control symptoms, and slow or even halt the progress of their disease. Surgical options may be appropriate in certain situations where severe joint damage has occurred.
Coping with inflammatory arthritis can be challenging. That is why it is important to learn as much as possible about your condition. We hope you will find the resources in this guide to be helpful.
Inflammatory Arthritis Clinic
The Inflammatory Arthritis Clinic assesses and treats patients affected with inflammatory arthritis. The IAC includes health providers dedicated to the care and improved understanding of these disorders. Over 60 patients are treated at this weekly clinic, where they benefit from the highest quality care provided by a multidisciplinary team that includes expert attending physicians who oversee fellows, residents and students as well as social workers, a radiologist, and scientists. Patients seen in the clinic can be participants in inflammatory arthritis registries and help with scientific studies and physician education.
Experts at the Inflammatory Arthritis Center have authored many articles on Inflammatory Arthritis. See below to learn more about specific types of this disease as well as treatment options.
Major types of inflammatory arthritis include the following:
Fast Facts about Inflammatory Arthritis
- Inflammatory arthritis refers to a group of disorders caused by an overactive immune system that results in inflammation.
- Inflammatory arthritis is also described as an autoimmune disease, which means that the body’s immune system sees its own healthy cells and tissues as “foreign”, and sets up to attack them.
- Most types of inflammatory arthritis primarily affect the joints, tendons and ligaments. However it can also affect the heart, lungs, skin, eyes and other organs.
- People with inflammatory arthritis can develop the disease at any age, even as toddlers.
- Symptoms of inflammatory arthritis depend on the type of the disease. Some forms, such as rheumatoid arthritis and psoriatic arthritis affect the smaller joints, while others, such as spondylitis, affect the spine.
- Inflammatory arthritis is different from osteoarthritis, a disease that is seen more with aging. (Osteoarthritis also affects the joints; however, this is not the result of the body’s altered immune response.)
- If left untreated, inflammatory arthritis can result in irreversible damage to the joints and other affected organs.
- Treatment can be most effective when it begins early on in the course of the disease.
- Rheumatologists are expert physicians specialized in diagnosing and treating inflammatory arthritis and autoimmune diseases where joints can be involved.
- With treatment, inflammatory arthritis can often be well-controlled and put into sustained remission, a state in which symptoms subside, and the risk of damage is greatly reduced.
Support and Education Programs
HSS offers a number of free programs that reflect our comprehensive approach to care for people with rheumatoid arthritis.
Early Arthritis Initiative
The Early Arthritis Initiative (EAI) is committed to the education of the community, local physicians, and individual patients. It was established to:
- Promote the early identification and treatment of arthritis
- Support research efforts to determine more effective treatment and prevention strategies for arthritis
- Provide essential support and education for people with a new diagnosis of inflammatory arthritis
Recent research has shown that early diagnosis and treatment of rheumatoid arthritis can dramatically change the course of the disease. Patients who wait too long to be evaluated and treated may miss out on a narrow window of opportunity to prevent unnecessary destruction of their joints. It is integral to our mission to raise public awareness about the benefits of early detection, diagnosis, and treatment of rheumatoid arthritis, through outreach and community education.
Treatments may include medication for inflammation, medication to prevent joint damage, referrals for exercise and physical therapy, and/or advice about nutrition and supplements. Patients also have the opportunity to learn about what is going on in the world of rheumatology research that could potentially improve their care.
The EAI offers regularly scheduled community lectures and support and education programs for people with RA, which offer unique opportunities for learning about this illness, both from medical professionals and from peers with the same diagnosis. These programs were developed to provide a welcoming forum where people with RA can share concerns and also have access to:
- Reliable, easy-to-understand illness-related information from healthcare providers
- Coping strategies and emotional support from peers who understand
Faculty and Staff
The EAI is staffed by a team of experienced physicians and clinicians who have expertise in the diagnosis and treatment of rheumatologic diseases.
- Theodore R. Fields, MD, Clinical Director, HSS Early Arthritis Initiative
- Vivian Bykerk, MD, Director, HSS Inflammatory Arthritis Center; Research Director, HSS Early Arthritis Initiative
- Adena Batterman, MSW, LCSW, Manager, RA Support and Education Programs
- Joan Westreich, LCSW, Social Work Coordinator, Early RA Support and Education Program
- Linda Leff, RN, Nurse Manager, HSS Infusion Center
Frequently Asked Questions
What kind of symptoms should be evaluated by a doctor if you suspect arthritis?
- Joint pain for less than 3 to 6 months
- Joint swelling or stiffness, particularly in the morning, for less than 3 to 6 months
Strong data shows that it is especially valuable for certain kinds of arthritis, like rheumatoid arthritis, to be diagnosed and treated very early.
Why should I see the doctor for a few aches and pains?
The latest research has shown the critical importance of early treatment of arthritis, especially rheumatoid arthritis and other inflammatory types of joint pain. The earlier you identify the cause of your pain, the better you’ll be able to fight the disease or find out what’s going on. This is particularly true of rheumatoid arthritis, where early identification and treatment can actually stop the disease from progressing further. If you have morning stiffness or swelling of joints, this is an especially important signal that early evaluation is critical.
Why did HSS start the Early Arthritis Initiative?
HSS has the largest rheumatology program in the United States. Many spend most of their time taking care of patients, and some spend almost all their time in research. The Early Arthritis Initiative reflects the collaboration between these two physician groups.
In 2008, the Hospital established the Inflammatory Arthritis Center based on "best evidence medicine" with the following intersecting tenets:
- Providing comprehensive care to patients with RA and spondyloarthropathies
- Educating medical students from the Weill Cornell Medical College, residents from NewYork-Presbyterian Hospital, and fellows and attendings from HSS
- Facilitating translational research by enhancing communication between basic science researchers and clinicians and formulate the foundations for clinical research at HSS
- Promoting basic and clinical collaborations with the pharmaceutical industry and participate in the development of novel therapeutics for patients with inflammatory arthritis
As part of its commitment to providing optimal care to patients, the IAC conducts a weekly clinic, followed by a conference involving rheumatology attendings, a radiology attending, medical students, residents, fellows, and social workers in an interdisciplinary discussion of patients with diverse clinical problems so as to highlight evidence-based therapeutic decisions and assessment of outcomes. The IAC has developed and implemented a comprehensive computerized registry and a database of patients with rheumatoid arthritis. Registries in other inflammatory conditions, including ankylosing spondylitis and psoriatic arthritis, are being developed. In addition, the IAC serves as a site of the national Consortium of Rheumatology Researchers of North America (CORRONA).
Three clinical trials that were incorporated into the IAC are nearing completion, and two new studies are soon to be launched. Proposals for several investigator initiated trials have been submitted on several topics including the use of a new anti-biological agent, certolizumab. In addition, several national and international database collaborations are being explored. An effort to promote a closer interaction between clinical and basic science research at HSS has been initiated. This translational approach has encompassed several activities, including a project on the characterization of cytokines and dendritic cells in patients with psoriatic arthritis. Two new fellowship research studies have been proposed that require the facilities of the IAC.
As the IAC continues to develop, the primary objectives will be to continue to build the respective registries so as to begin generating hypotheses, research studies, and publications that cross the basic science and clinical platforms.
Conversations With Experts
Optimal Therapy: Triple Therapy Versus Methotrexate Plus an Anti-TNF Medication
Dr. Vivian Bykerk with Dr. Stephen Paget
Advances in the treatment of inflammatory arthritis have made a dramatic difference in the lives of people with this disease. However, there is still much to be done. In the IAC, our goals are to expand the understanding of how and why inflammatory arthritis develops and to improve patient care. Below are some of our ongoing research projects.
Accelerating Medicines Partnership (AMP)
The Accelerating Medicines Partnership (AMP) is a multiyear NIH funded translational research project across numerous sites in the United States. At HSS, Vivian Bykerk, MD, is principal investigator (PI) with co-PIs Lionel Ivashkiv, MD, and Alessandra Pernis, MD. AMP’s primary research focus is to facilitate understanding of RA pathogenesis in differing patient subsets in order to advance aims of precision medicine. Dr. Bykerk and Laura Donlin, PhD, have developed a research program to recruit people living with RA. These patients with joint inflammation volunteer to provide their joint tissue, either at the time of surgery or via a needle biopsy along with information about their health, disease status and treatment. Their collected data will facilitate scientific studies that can discover new mechanisms in the immune system that contribute to the disease and could be targeted for treatment.
The release of the new data for public use in early 2018 speaks to the effectiveness of the AMP RA consortium, a group of engaged researchers across the USA, to provide information that will allow even more scientists to study how the immune system works in rheumatoid arthritis.
Learn more about AMP on NIH.gov
Other IAC Research Studies
To be eligible for all IAC studies (except StopRA), one must be under the care of an HSS rheumatologist.
Actively Enrolling Research Trials
A study of newly diagnosed rheumatoid arthritis (RA) patients (joint symptoms lasting for less than one year)
Patients have different experiences with their RA, requiring different levels of treatment. However, research suggests that many patients are not treated in the way that could best improve their outcomes.
The goal of CATCH-US is to better understand predictors of treatment response in early RA patients. Vivian Bykerk, MD has overseen the expansion of this observational study of ERA and RA patients to Johns Hopkins in Baltimore, MD, with additional sites in the New York area beginning in early 2018.
For additional information about CATCH-US please email Michael McNamara.
Also clinicaltrials.gov NCT identifier # NCT02386527
Phase I of the AMP research at HSS was launched in 2014 with projects in three disease areas including rheumatoid arthritis. Patients with early or established RA who are undergoing synovectomy or synovial biopsies are asked to provide their synovial tissue for research. Patients are also asked to answer standardized patient reported outcome measures regarding their disease activity and well-being. Tissue provided for these studies will be completely de-identified and will undergo routine histologic examination and scoring for level of inflammation. Techniques used will include RNA sequencing, ATACseq, or a highly similar technology.
The NIH has recently released datasets from the phase 1 study. The release of this new data for public use speaks to the effectiveness of the AMP RA consortium to provide information that will allow even more scientists to study how the immune system works in rheumatoid arthritis.
For additional information about AMP Synovial Biopsy please email Michael McNamara.
For patients diagnosed with ankylosing spondylitis (AS) and psoriatic arthritis (PsA)
IAC Investigators are interested in learning more about spondyloarthritis (SpA). We are actively collecting data on consenting patients with specific types of SpA, including ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Eligible AS and PsA patients include those who, for the preceding three months, have not received biologic treatment such as adalimumab, etanercept, infliximab, golimumab, certolizumab pegol, or other biologic therapies.
Usual care for patients with AS or SpA would include regular assessments of pain, function, mobility, spine, and joint motion, etc., about twice a year. Treatment interventions may include physical therapy, analgesics, NSAIDs, DMARDs or biologic therapies. As part of the HSS SpA Cohort, this detailed information would be recorded at pre-determined intervals, along with clinical information such as disease activity, tender and swollen joint counts, dactylitis, enthesitis, and spine involvement.
For information about the HSS SpA Cohort, email Shirin Dey.
Active Research Closed to Enrollment
A Multicenter, Randomized, Double-blind, and Placebo Clinical Trial
StopRA is a 3-year funded, US-based, rheumatoid arthritis prevention study, the first of its kind. It is a multicenter randomized controlled trial in which either hydroxychloroquine or placebo is administered for 1 year followed by 2 years of observation, to people identified as being at high risk of developing RA (active synovitis). These subjects will be selected because of the presence of elevations of the RA-related autoantibody anti-CCP that are greater than 2 times the normal cut-off level (i.e. anti-CCP3 ≥ 40 units), a biomarker status that is highly specific for future RA (>90%), and also indicative of the imminent onset of clinically-apparent disease. The primary endpoint of the study is the development of clinically apparent RA by 36 months.
In addition to the Inflammatory Arthritis Center at HSS, locations participating in this national study include:
- Cedars-Sinai Medical Center
- Emory University
- Oklahoma Medical Research Foundation
- University of California, Los Angeles
- University of Chicago
- University of Colorado
- University of Minnesota
- University of Pittsburgh
- University of Pittsburgh
- University of Michigan
- University of Alabama: Bridges
- Brigham & Women's Hospital
- Northwell Health
- U Mass Memorial Medical Center
- University of Nebraska
- Essential Health-Duluth
- Mayo Clinic
For additional information about StopRA please email Serene Mirza or visit http://www.stop-ra.org.
Also clinicaltrials.gov NCT Identifier # NCT02603146
Despite marked improvements in survival in the US population in the past 2-3 decades, rheumatoid arthritis associated mortality rates have not declined. Cardiovascular disease has been consistently identified as the leading cause of excess deaths in RA, and it is believed that this increased CV risk in RA is likely due to enhanced vascular or systemic inflammation.
TARGET (Treatments Against RA and Effect on FDG PET-CT) aims to compare the effect of two different RA treatments on cardiovascular health in patients who are considering a treatment change. The study is recruiting patients who are only taking methotrexate and are switching treatment due to a lack of improvement. The trial will randomize participants to take a TNF inhibitor (Enbrel or Humira) in addition to their Methotrexate or to take Triple Therapy (Methotrexate + Sulfasalazine + Hydroxychloroquine). Cardiovascular health will be measured by comparison of two FDG-PET/CT scans taken before and after the treatment change. Study involvement requires two FDG-PET/CT scans and six follow-up visits over a period of six months.
For additional information about TARGET please email Michael McNamara or visit http://www.targetra.org.
Also clinicaltrials.gov NCT identifier # NCT02374021
The SEAM Study: Patients with RA who are already on etanercept and methotraxate
Etanercept has become a well-established agent in the management of rheumatoid arthritis or RA, and can be used either as monotherapy or in combination with methotrexate. Dr. Vivian Bykerk along with members of the Inflammatory Arthritis Center will be studying patients with RA who are already on the combination of etanercept and methotrexate, and are beginning to enroll subjects for this study which will evaluate the effectiveness of three separate treatment regimens on maintaining remission of RA:
- Etanercept monotherapy
- Methotrexate monotherapy
- Combination etanercept plus methotrexate therapy
The clinical hypotheses are:
- Etanercept monotherapy is superior to methotrexate monotherapy for maintaining remission in subjects with RA who were on etanercept plus methotrexate therapy.
- Etanercept plus methotrexate therapy is superior to methotrexate monotherapy for maintaining remission in subjects with RA who were on etanercept plus methotrexate therapy.
To discuss collaboration or participation in the SEAM study, or for any additional details, please email Shirin Dey.
Complete study details including additional study sites are listed on www.ClinicalTrials.gov, NCT# 02373813.
Click here for the SEAM study
View all clinical trials at HSS
PROMIS (Patient Reported Outcomes Measurement Information System)* is an NIH-funded system of highly reliable, precise measures of patient-reported health status for physical, mental, and social well-being. Recent studies suggest that PROMIS may also provide additional data that is useful during clinical visits for facilitating shared decision-making and long-term disease management. The goal of the PROMIS RA Interview Study is to study the responsiveness (sensitivity to change) of selected PROMIS measures in people with RA and establish minimally important differences for these measures. This information is necessary before measures can be adopted and used in clinical care and research.
We have completed enrollment for PROMIS at HSS. For additional information about the PROMIS RA Interview Study at HSS please email Annie Hoang.
* Information about PROMIS is available here.
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