This is the second in a short series of posts in honor of the blog’s 2nd birthday. We are looking at some significant topics that have surfaced over the last two years. I’m calling these “frying pan posts” since these issues are critical enough to patients to speak rather bluntly.
Why monitor Rheumatoid Arthritis?
You have your RA diagnosis. You got treatment. Why would you need more tests?
This is a common question that comes up in various forms. The question is based upon naiveté about Rheumatoid Arthritis. Regular readers or anyone living with RA knows of the lack of insight about what RA is, even in the medical community.
RA is a chronic, systemic, progressive, destructive disease. None of that would matter much if there were a cure. However, since no cure is available, and treatments are only modestly successful in a significant percentage of patients, monitoring Rheumatoid Arthritis is required to preserve as much health and life as possible.
1) We must treat people, not diseases
Let’s use monitoring a childhood illness as a simple demonstration.
- If my son gets a cold, I might give him juice, vitamin C, and rest.
- If he begins to cough, I may add cough suppressant to his treatment.
- When he cries that his ear hurts, I can take him to our pediatrician who observes an inflamed eardrum and prescribes an antibiotic.
- At this point, if my son spikes a fever, I’ll take his temperature and administer ibuprofen.
- At no point in time would anyone suggest that I tell my son that since he has been treated for his malady, he does not need further care. I will continue to treat both the symptoms and the causes of his illness for as long as they exist.
- And if his eardrum is damaged, despite conscientious medical care, I’ll continue to care for him, even if it requires surgery or a hearing aid.
Disease treatment is sufficient for Rheumatoid Arthritis only if a patient responds exceptionally well. Reliable sources say only six percent of people with RA get remission. Clinical trials for biologic treatments consistently have shown only 20% reach an ACR 70 (70% improvement). Every RA patient ought to be monitored because they are at risk for numerous effects of RA such as bone erosion, spinal instability, osteoporosis, heart disease, and eye or lung problems.
When RA patients experience any loss of function or pain or any secondary diagnosis to RA, these matters must be addressed regardless of the patient’s apparent response to treatment. Patients must receive adequate monitoring to promote timely treatment, especially with regard to symptoms they experience.
2) Treating to target necessitates monitoring
There has been recent interest in treating Rheumatoid Arthritis to target since it has been useful with other complex diseases like diabetes. There also are newer more stringent definitions of Rheumatoid Arthritis remission. While groundbreaking, none of these approaches reach patients without thorough and regular monitoring of RA disease activity.
A recent article by Smolen and Aletaha discusses methods of Monitoring Rheumatoid Arthritis, concluding that:
“The data presented provide compelling evidence on the importance of monitoring patients with RA clinically at regular and tight intervals throughout the course of their disease, including remission. This monitoring allows not only optimization of the outcome by the treat-to-target approach, but also detection of flares during remission and timely re-introduction of DMARD therapy.”
Discrepancies between perceptions of disease activity, pain, and functional status have all been documented and affect treatment decisions. This systemic problem could be partially addressed with consistent standards for monitoring. Much knowledge could be gained about Rheumatoid Arthritis if more patients were monitored as described by Smolen.
I urge you to read or re-read the first post in this series, Rheumatoid Arthritis Swelling, Take Two, with images of internal swelling. If we can encourage a clearer understanding of these issues, it could bring dramatic improvement in the care of people with RA as well as diagnosis and study of the disease.
Note: Interpretation of tests, problems attaining tests, and need for better tests to monitor Rheumatoid Arthritis are all important topics for discussion and will be the subject of other posts.