Rheumatoid Arthritis Fast Facts
Early Diagnosis is Essential
There is now a need to identify patients with rheumatoid arthritis in earlier stages of disease and to treat early so as to avoid joint damage. In early stages of disease patients can test negative for the blood test called rheumatoid factor in upto 50% of cases, and in established disease negative tests occur in 20% of patients. Responding to the need for earlier diagnosis, we have seen the proliferation of “early arthritis clinics” where patients are typically seen with less than 12 months of symptoms and attempts are made to classify them as whether they are at risk for developing full blown rheumatoid arthritis, based on certain criteria. Certain diagnostic modalities, including ultrasound and MRI of small joints have been useful to detect early bony erosions which have not been apparent on x-rays.
A new blood test called anti CCP (cyclic citrullinated peptide) is sometimes useful in patients who have rheumatoid factor negative undifferentiated arthritis. The presence of anti-CCP in these patients predicts a higher likelihood of developing rheumatoid arthritis. In patients with established rheumatoid arthritis, the presence of CCP antibodies can indicate a poorer prognosis, signaling a need for earlier and more aggressive treatments.
Disease modifying drugs should be used as soon as diagnosis of rheumatoid arthritis is made. The traditional drugs have included methotrexate, sulfasalazine, hydroxychloroquine, and more recently, leflunomide.
Newer treatments now available:
Tumor necrosis factor (TNF) blockers: All three of the available TNF blockers (Humira, Enbrel, Remicade)have led to quantum clinical improvement over that obtained with methotrexate alone. Infections, such as non serious infections (coughs, colds) or reactivation of hidden or latent tuberculosis, can occur with use of these medications. Overall all of these medications are safe, work very well and the risks are low. In fact methotrexate as well as the newer anti TNF therapies have been shown to prolong the life span of patients with arthritis. Newe treatments such as Rituximab, Actemra, and Orencia are also in use in Dubai.
Dr. Humeira Badsha, Consultant Rheumatologist, in Dubai, located at Al Biraa Arthritis and Bone Clinic +971 348-7031