The physicians and healthcare professionals at the Inflammatory Arthritis Center are committed to improving the lives of people with inflammatory arthritis through individualized, high-quality patient care; education services for patients, family, caregivers and policy makers; and clinical research initiatives designed to gain a better understanding of the causes of inflammatory arthritis and to bring new innovations to patient care. As an internationally recognized Center of Excellence, the IAC is also training the next generation of medical providers.
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.
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, scientists, nutrition services, occupational therapy and physical therapy. 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:
HSS offers a number of free programs that reflect our comprehensive approach to care for people with rheumatoid arthritis.
The Early Arthritis Initiative (EAI) is committed to the education of the community, local physicians, and individual patients. It was established to:
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:
The EAI is staffed by a team of experienced physicians and clinicians who have expertise in the diagnosis and treatment of rheumatologic diseases.
What kind of symptoms should be evaluated by a doctor if you suspect arthritis?
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:
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.
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.
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.
The Accelerating Medicines Partnership (AMP) is a multiyear, NIH funded, translational research project across numerous sites in the United States. Vivian Bykerk, MD, a co-principal investigator (PI) at HSS and Laura Donlin, PhD, have developed a research program to recruit RA patients with joint inflammation. These patients 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. This detailed patient data and biospecimen information will facilitate scientific studies that can discover new mechanisms in the immune system that contribute to the disease and could be targeted for treatment.
We are the lead site for the multicenter CATCH-US study, in which people with new onset RA and or recent onset RA, with joint symptoms lasting for less than one year, can voluntarily participate. It’s an observational study to determine factors that best predict response to treatment choices and outcomes.
Patients have different experiences with their RA requiring different levels of treatment. 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.
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 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, please email Caroline Reidy, MPH.