Early Diagnosis and Treatment of Rheumatoid Arthritis May Reduce Permanent Joint Damage

Doctors cite a “narrow window of opportunity;” offer warning signs

New York, NY—May 5, 2005 

Research and advances in clinical practice are increasingly demonstrating that a narrow "window of opportunity" to slow down or potentially halt joint damage caused by rheumatoid arthritis (RA) may exist in the early stages of the disease, according to doctors at Hospital for Special Surgery (HSS).

"There is a therapeutic window of opportunity to prevent joint damage in RA, and that window opens early," said Theodore Fields, MD, a rheumatologist and clinical director of Hospital for Special Surgery’s Gosden Robinson Early Arthritis Center (EAC). "We have treatments available today that can put the brakes on the progression of rheumatoid arthritis. But the real key is avoiding delay in treatment."

Many RA patients do not seek medical help because they erroneously assume nothing can be done for arthritis. Others may experience delayed therapy because their primary care physicians don't realize or accept the treatment advances that have resulted from rheumatology research in the last ten years. Doctors at Hospital for Special Surgery’s Early Arthritis Center stress that RA often begins with inflammation in a few joints. Once that pain persists for three or more months it is unlikely to go away on its own and often spreads to multiple other joints.

"Waiting too long to be evaluated and treated by a rheumatologist can result in unnecessary joint destruction. We’ve developed a group of early warning signs patients can use to determine if they need to see a rheumatologist," Dr. Fields added.

HSS offers the following six warning signs of RA to help patients determine if they should visit a rheumatologist:

• Persistent pain in your joints for more than a week
• Morning stiffness in your joints lasting over ½ hour
• Pain or tenderness when you squeeze your hand or move foot joints
• Swelling, warmth, or redness in your hand or foot joints
• Persistent limitation of motion in more than one joint
• Joint pains combined with fatigue, fever or weight loss

According to the Arthritis Foundation, a co-sponsor of National Arthritis Month in May, rheumatoid arthritis afflicts one percent of the U.S. population (2.1 million Americans). Three fourths of these RA sufferers, about 1.5 million, are estimated to be women.

Treatment of RA that focuses only on pain relief, and not joint damage prevention, often leads to poor long-term results. However, when RA is treated within the first three to six months after symptoms are first noticed, research has shown that patients experience improved outcomes. A study by a Dutch research group demonstrated that patients who received early treatment of recent-onset RA experienced less joint deterioration at two years after diagnosis than those who received later treatment (1). Early treatment can include:

• Physical therapy and various anti-inflammatory medications
• Oral medications like methotrexate that can stop joint damage
• Combinations of methotrexate with newer biologic therapies designed to be very specific for some of the inflammatory chemicals, called cytokines, which cause the damage and pain in RA

Rheumatologists look at a number of factors to try to predict the long-term risk of joint damage, including:

• Positive blood test, the rheumatoid factor, that predicts more chance of joint damage
•  Joint x-ray showing damage or bone thinning
• MRI or ultrasound study that can show early joint damage that is invisible on x-ray

Over 100 kinds of arthritis exist, making it important that inflammatory-type arthritis – with RA being the most common type of inflammatory arthritis – be quickly identified. It is important to separate inflammatory arthritis from degenerative arthritis like osteoarthritis – a degenerative "wear and tear" joint disease that is the leading cause of disability in the United States – since treatment is completely different. Osteoarthritis ends to affect people over 50 and increases with age, while inflammatory arthritis such as RA has its most common onset between the ages of 30 and 50. Since RA commonly affects people in their child-bearing and peak-earning years, the disability can be costly for both patients and society. According to the Arthritis Foundation, fewer than 50 percent of working age adults with RA are still employed ten years after disease onset. The best hope for improved outcomes for individuals with RA is early diagnosis and treatment.

About the Gosden Robinson Early Arthritis Center
The Gosden Robinson Early Arthritis Center (EAC) was founded to promote the early diagnosis and treatment of arthritis and to support research efforts to determine more effective treatment and prevention strategies. The EAC connects patients quickly and efficiently with a rheumatologist who can evaluate joint pain and start an appropriate course of treatment. The patient’s primary care physician is kept fully advised of findings and recommendations. The Gosden Robinson Early Arthritis Center (stoparthritis.hss.edu) is located at Hospital for Special Surgery at 535 East 70th Street in Manhattan (Toll-free patient hotline 866-807-8018).

About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology by U.S. News & World Report (2007), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In the 2006 edition of HealthGrades' Hospital Quality in America Study, HSS received five-star ratings for clinical excellence in its specialties. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Medical College of Cornell University, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Medical College of Cornell University. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.