The Progression of Rheumatoid Arthritis

  • The new millennium started with the scare of Y2K - remember that? Everyone was convinced the sky would fall the minute the clock ticked over at New Year's, but thankfully nothing happened. For people living with RA, the new millennium didn't look much different, but the seeds of a revolution had started and now, as I sit by my computer thinking about what has changed for us in the past 10 years, I look at a entirely different landscape.


    Late in the year 1998, the FDA approved a new kind of drug called a biologic, genetically engineered from proteins for the treatment of RA. This first biologic was Enbrel. It started quietly, not being used by too many initially, but when it became apparent how effective it was, prescriptions increased. A year later, Remicade came on the market and in December 2002, Humira was approved. These drugs changed the prognosis of RA.

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    It's such a small sentence, but it hides within it so profound a shift both in the treatment of RA and in the knowledge base for research that it can only be called a miracle. Before, having RA set you on a path of inevitable damage, deformity and disability, the disease eating your joints, your ability and your life. Sure, there were some treatments, but they were few and not very effective. You picked the one that worked the best, loaded up on NSAIDs and limped along while your joints twisted into shapes no joints should have. The Biologics changed all that. When they work - and they often do - they work so well that people are now living fairly normal lives, traveling to the other side of the world, playing recreational soccer, keeping their jobs and best of all, joints no longer have to twist into nightmarish shapes. In fact, it has been said that the Biologics changed the treatment landscape so significantly that doctors now don't know what kind of prognosis to give their patients. These kinds of drugs are so new that we still don't know how far it is possible to go.


    Now, in late December of 2010, we have nine biologic medications on the market and more are in the process of being researched, tested and submitted for FDA approval within the next few years. Some of these - like the JAK inhibitor - is being developed in pill form, thus freeing us from reliance on syringes and refrigerated drugs.


    These new discoveries of modifying biologic responses by inhibiting this protein and that have changed the future and given us options. Many options. They are hope made tangible, each discovery building on the next and just this past year, researchers started work on a medication to turn off RA entirely. Can you imagine what the future might hold?


    A Deeper Understanding of Pain
    Pain is a part of your world when you live with RA, but getting the pain treated can be a challenge. Despite the fact that chronic pain severely limits people's lives, as well as costs society more than other chronic conditions, such as heart disease, hypertension and diabetes, treatment of pain is still fighting an uphill battle against social myths about stiff upper lips, addiction and suspicion about an individual's report of pain.


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    The good news is that there is a growing understanding that pain is a condition, a disease in itself. Research into the experience of pain is giving us the evidence that show that pain isn't just pain - it's a complex neurological process composed of sensation, memory, learning and emotion. As well, people living in pain are now connecting through organizations such as the American Pain Society and the International Association for the Study of Pain are giving us a voice at the political level, bringing increased awareness of the personal and social costs of pain. We now have real hope that we can create a future in which there is a different perception of pain and therefore a focus on improving treatment of pain.


    The Internet
    In the past 10 years, the Internet has gone from being the realm of the geeky to being used by everyone in ways we couldn't even imagine in the year 2000. For those of us who live with a chronic illness, the Internet has become a lifesaver. It is a library in your home, enabling you to research RA, medications, surgery, the law and every other thing you can imagine that pertains to your disease. And more than that, it has become a lifeline, linking you to others who have RA. Online communities like MyRACentral connect you to strangers who become friends, people with whom you can share support, camaraderie, helpful tips, the kind of understanding that only someone who's been there can offer, to hugs and laughter.


    This past decade has seen more development of treatment and support than ever before. For the first time in living memory, we look to a future filled with hope and hope is essential to living well with RA. I can't wait to see what will happen next!


    All of us here at MyRACentral wish you a New Year's be filled with love, laughter and the kind of meds that help you get back to life. See you in 2011!



    Lene is the author of the award-winning blog The Seated View.

Published On: December 29, 2010