Early Diagnosis Key for Treating RA

Early diagnosis and treatment are critical for any medical condition. They’re even more important when it comes to rheumatoid arthritis (RA) because the damage the disease causes to joints cannot typically be reversed. Rheumatologist Robert McLean, MD, regional medical director, Northeast Medical Group, New Haven, said current treatment options can help RA patients lead fuller lives, if the disease is caught early.

“People will frequently ask me if they have arthritis,” Dr. McLean said. “If they’re old enough, it’s almost always ‘Yes’ because most people get some type of degenerative joint disease or osteoarthritis, which comes from normal wear and tear. But as a rheumatologist, I ask questions about the patterns of their pain which can steer us to something that may be rheumatoid arthritis or some other inflammatory arthritis.”

What is RA?

While osteoarthritis is a degenerative joint condition that results from breakdown of joint cartilage and bone, rheumatoid arthritis is a chronic inflammatory disorder that primarily affects the joints. In RA, the immune system begins to attack the healthy joint tissue, leading to pain, swelling and loss of joint function.

“RA tends to impact both sides of the body equally,” Dr. McLean said. “It can show up in large joints like the knees, but RA generally impacts joints in the hands. We see it in the knuckles at the base of the fingers and in similar joints in the feet.”

There are several blood tests that can help diagnose RA, but Dr. McLean added that no one test is perfect and that a blood test, together with a clinical exam constitute the gold standard for diagnosing RA.

Start with your primary care clinician

“If someone is having joint pain that just seems to be lingering, they should bring it up with their clinician,” he said. “Primary care is a great place to start because not everyone who has joint pain needs to see a rheumatologist. A primary care clinician can go through those first steps and if they suspect an inflammatory arthritis, make a referral to a rheumatologist.”

RA damages the impacted joints and the damage frequently increases the longer the disease goes untreated. That damage can be irreversible. That is why Dr. McLean encourages patients to talk with their clinician when they first notice joint pain.

“We can run all of the tests and if we find that the patient has really high levels of some of these inflammatory markers, that’s a pretty strong signal that they will have a more aggressive course of RA,” he said. “When that’s the case, studies show that aggressive early treatment can really limit the extent of the joints getting damaged.”

New treatments prove effective

Newer anti-inflammatory drugs called TNF (tumor necrosis factor) inhibitors have shown to be particularly effective at reducing RA damage in many patients who have not seen adequate improvement from older medications. “Some of the newer medications are more commonly known by their brand names like Enbrel® and Humera®,” Dr. McLean said. “Using these newer medications and treating RA earlier rather than later has led to improved quality of life for many patients, compared to years ago.”

People with RA tend to avoid moving the affected joints because of the pain and discomfort. Improving range of motion is a treatment goal, but Dr. McLean advises patients to wait until the inflammation subsides before starting any physical therapy.

“If there’s a lot of inflammation around a joint, we’ll see that the tendons are irritated and if you’re aggressively moving those joints, you can cause more harm,” he said. “Our goal is to quiet down the inflammation, get the patient feeling better, get the joint better and then start some range of motion exercises or physical therapy to strengthen the muscles and tendons.”

Over-the-counter meds for lower pain levels

For his patients who report lower levels of joint pain without a specific diganosis, Dr. Mclean recommends over-the-counter medications like ibuprofen over the course of five to 10 days. “If that is effective, that’s great news because we know the inflammation can be controlled relatively easily. But if those over-the-counter pain relievers don’t help very much, that is a very important piece of information because now I know we have to look at stronger medications to help them feel better,” he said.

With so many treatment options for the different levels of severity of RA, Dr. McLean urges anyone who has a nagging pain in their joints to talk with their doctor.

“The earlier you speak with your doctor, the quicker we can get a diagnosis and get started with these treatments,” he said. “And the sooner we start the treatments, the better off you’re going to be.”

Learn more about rheumatology.