With that kind predictive power, physicians could make a proactive strike, potentially slowing down disease damage or even stopping it in its tracks.
Developments like this one underscore how dramatically the rheumatology field has evolved in the past decade, says Allen Anadarajah, M.D., medical director of the University of Rochester Medical Center’s Early Arthritis Clinic – one of only about a half dozen such centers recognized nationally.
“We now have a window of opportunity to make a life-changing difference for patients with rheumatoid arthritis, especially if we begin treating symptoms within the first three months,” he said.
URMC’s clinic aims to do just that – fast-track appointments for this special clinic, aiming to see new patients in just two weeks.
“That’s lightning speed in the midst of a national rheumatologist shortage,” Anandarajah said. “But we believe acting at the first signs is incredibly important. More than fifty percent of patients, if untreated for a year, will suffer joint damage. And half of all RA patients who go untreated – or are treated too late – wind up disabled by the third year of the disease, making it the most common, potentially treatable cause of disability in the Western world.”
Acting Fast Saves Joints
Rheumatoid arthritis (RA) is an autoimmune disease, in which immune cells (the body’s defense wardens) misguidedly attack its own joints, causing inflammation, pain, swelling, and irreversible damage. RA affects 1 to 2 percent of the population and typically onsets between age 40 and 60, striking women three to four times as often as men. While it’s suspected to trickle down in family trees, smoking can greatly exaggerate one’s risk.
Patients are encouraged to seek specialist care at the first subtle indicators of disease, which include swelling and pain in the small joints (fingers and toes are tender to the touch on both sides of the body), as well as “morning stiffness” that lasts more than one hour. A rheumatologist can confirm diagnosis by ordering an anti-CCP (cyclic citrullinated peptide antibody) test, which is somewhat similar to (but much more routinely used than) the Swedish blood that caused media buzz earlier this year.
“Our goal aims far beyond just masking symptoms,” Anandarajah said. “Once we’re certain a patient has RA, we have an arsenal of treatments at our disposal, including newer injectable biological medicines that seem to abate symptoms and stall joint damage.”
These early clinics have gained traction in Europe, Anandarajah added, but the U.S. has been slow to climb on board.
“Many physicians are still of the ‘let’s wait and see’ mindset, and that can be devastating to patients,” he said. “The disease can move quite fast in its first months.”
Patients often travel from Buffalo, Syracuse and much farther away to visit URMC’s early arthritis clinic, which, in addition to being just one of a handful of such centers nationwide, boasts ultrasound technology as an inexpensive, at-the-fingertips tool for viewing soft tissues instantly. Performed right in the office, ultrasound generates live images that provide diagnostic information instantaneously (no time is necessary to develop or review, and there’s no need to schedule an additional procedure). Images or video clips also can be saved for later comparison – all at about a tenth of the cost of an MRI (Medicare estimates approximately $120 per ultrasound). As another perk, since many RA sufferers also are at increased risk for low bone density (either disease-induced, or perhaps a side-effect of RA medications), the clinic folds in an osteoporosis prevention/treatment program, including on-site bone density scanning.
“In addition to having the expertise and equipment available right in our clinic, by cohorting these patients we’re also in a strong position to serve as a trial site for exciting clinical research opportunities, like those in Sweden,” Anandarajah said.
To learn more about URMC’s early arthritis clinic, click here. To schedule an appointment, call (585) 341-9200.
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