What's New with Rheumatoid Arthritis: Langone Medical Center Webinar

Patient Expert

Last week, I attended a webinar hosted by the NYU Langone Medical Center entitled What's up with RA: Living Today and Looking Forward.

The webinar presentations were given by three staff from the Langone Medical Center, each speaking to their area of expertise. These presentations included an overview to RA, a new perspective from the clinician's point of view and a talk about new knowledge within the pathogenesis of RA, i.e., how RA develops. This post will give you a brief summary of each presentation. If you are interested in learning more, the NYU Langone Medical Center has posted the full webinar with slides on their website. You can also download it for later viewing.

Overview of RA

The first presentation was by Steven Abramson, MD. Dr. Abramson is Professor and Director of the Division of Rheumatology and Co-Director of the Center of Excellence On Musculoskeletal Disease.

Dr. Abramson provided an introduction to RA, mentioning that we have only known about the disease since the mid-1800s. The advances in treatment with the Biologics have reenergized research and the last 10 years has seen an increase in the knowledge about what causes RA. More is now known about "agents in the environment that induce an immune response in people with a genetic predisposition to develop RA." One interesting development is the discovery that a certain bacteria in the gut can lead to the development of an RA-like illness in mice.

Dr. Abramson also emphasized the importance of treating RA aggressively and for people who live with the illness to seek treatment by rheumatologist. Too many are treated by their primary care physician and this can lead to being undertreated and therefore put them at risk for joint destruction and disability. This presentation was concluded with Dr. Abramson urging people with RA to educate themselves by seeking out information from reputable sources, to advocate for themselves and others and to communicate with their doctors to get better treatment.

The Clinician's Point of View

Dr. Soumya Reddy, Assistant Professor of Rheumatology and Co-Director, NYU Psoriasis and Psoriatic Program presented on new goals for treatment of RA. Dr. Reddy discussed the new classification criteria for RA used for clinical trials which will help identify people at high risk for developing severe and destructive disease. This will lead to better control of RA before it causes significant disability. Dr. Reddy also mentioned that damage can appears much earlier on an MRI then on an x-ray and emphasized that this, along with the move to early aggressive treatment, is important to communicate to primary care physicians and people who have RA.

Also covered in the second presentation was treatment approaches. In the past, the approach to treatment was to use the pyramid model to "start low and go slow." This is no longer appropriate and Dr. Reddy shared the model of "treating to target" and aiming for "tight control" of RA in the same way that diabetes and high blood pressure are approached (for more details on this, listen to the presentation or see my post on the RA forum I attended last year in Toronto). In addition to showing the much increased number of treatments available, Dr. Reddy also discussed comorbidities, i.e., diseases that occur with RA. Examples of such comorbidities includes heart disease, respiratory disease and depression. She shared that such comorbidities are not managed well due to inadequate communication with patients and between rheumatologists and primary care physicians.

From the Bench: Pathogenesis of RA

Dr. Gregg J. Silverman, professor of Medicine and Pathology, Co-Director, Center of Excellence on Musculoskeletal Disease talked about how RA develops. Dr. Silverman described that RA is a mix of genetic predisposition and environmental triggers. The human genome project has made it possible to identify a link between specific genes and RA. Some of the environmental triggers may occur in the lungs through e.g., smoking, in the mouth through periodontal disease or in the gut through intestinal micro bacteria.

Dr. Silverman also mentioned that antibody positive and antibody negative RA may be two different diseases and that more research is needed to gain a better understanding. People with sero-positive RA have a higher risk of ischemic heart disease and early mortality, but Dr. Silverman shared that the use of TNF blockers such as Enbrel lowers this risk.

This was a fascinating webinar covering a wide variety of topics related to RA. I highly recommend you listen to the whole thing - it will enhance your knowledge of the disease that shares your life and enable you to be a better advocate for yourself within the medical system.

NB: Lene is on vacation until July 5, 2011. She will respond to your comments when she returns.