Get expert answers to some of the top questions about rheumatoid arthritis.
Allan Gibofsky, MD, is a professor of medicine and public health at Weill Cornell Medical College and attending physician at the Hospital for Special Surgery, both in New York City.
As a doctor who sees many patients with RA, what kind of information do you wish your patients would share with you?
I think it's important for a physician to know about the patient's day-to-day functioning. It's a problem when a patient just accepts limitations on his or her daily functioning. We don't want patients to settle. We want patients to be aggressively treated. Feeling "better" isn't sufficient.
Why is this type of aggressive approach important?
One common misconception is that rheumatoid arthritis is like "my grandmother's arthritis"—I just have to take an occasional aspirin and it will get better. Rheumatoid arthritis is a chronic systemic disease that can affect all organs in the body.
We also tend to forget about the effects of systemic inflammation for a patient with RA: fatigue, weakness, depression and difficulty getting out of bed. This happens to varying degrees in all patients with RA, depending on what therapies they are using. This disease also affects the mental health of the patient.
How do you make treatment decisions for your patients?
As clinicians, we look at three things: (1) Are my patients getting relief from the signs and symptoms of RA, such as reduced tenderness and swelling in the joints? (2) Are my patients reporting improved outcomes? When they tell me how they feel, is it getting better? (3) What do the x-rays tell me? Are we inhibiting the structural progression of the disease?
A doctor has to take all three factors into account. I may have a patient who says he or she feels lousy, but the x-rays show the RA is not progressing in the joints.
But because this patient feels lousy, I have to treat him or her. I may have another patient who tells me he or she feels great, but the x-ray results look lousy. As a doctor, I still have to do something to treat this person—even if he or she is resistant—because I have to slow the structural progression of the disease, not just treat the symptoms.
What is a biologic medication?
A biologic is a medication that is given to reduce the effects of naturally occurring substances in your body. People shouldn't be scared of taking biologics to treat RA. Insulin is an example of a biologic many people have heard of; it's a drug given to people with diabetes who need to replace the insulin in their bodies.
A rheumatoid arthritis biologic is just a medication that counteracts the effects of abnormal levels of substances in the body that are leading to inflammation.
Why are some RA medicines available as an injection or shot, while others are an IV?
The different delivery methods have mostly to do with the preparation of the drug. Drugs are administered by injection or IV, depending on how the drug can best be absorbed by your body.
Is it true that medicines administered by IV are "stronger" or that they have more side effects than those in a shot?
No. It has more to do with how they are best absorbed by the body. Whether RA medication is given by shot or by IV, there are the same concerns and risks for the body. There is no evidence to suggest that medication given by IV is any stronger or that it works any better than medication given by injection.
Researchers have identified a cluster of genes that may be responsible for RA. What does this tell us about the disease?
Your environment, genetic background and clinical presentation are all important factors in your RA. Even if you have a genetic background predisposing you to the disease, it would still require an environmental trigger for you to get the disease.
For example, we know smoking is a factor in the RA disease process. Does it cause RA? No. Are there smokers who don't have RA? Of course. Are there people with RA who never smoked? Yes. We can't say smoking is a cause of RA; it's just a factor. It's good that we are working to better understand the genes involved in RA, but genes are not the whole story.