Rheumatoid arthritis (RA) is a systemic, chronic, progressive, autoimmune disorder that affects, roughly, two million Americans. While it preferentially attacks joints, it may affect other organ systems. These other areas include the lungs, heart, peripheral nervous system, skin, bone marrow, and eyes.
If Rheumatoid arthritis is suspected, a patient should be referred to a rheumatologist (arthritis specialist) as soon as possible. The current goal of Rheumatoid arthritis therapy is to treat and control disease before any joint damage has occurred. A rheumatologist can help by making the diagnosis and initiating disease-modifying anti-rheumatic drugs (DMARDS) to slow down disease as soon as possible.
One new development in establishing the early diagnosis is the 2010 American College of Rheumatology/ European League Against Rheumatism Classification Criteria that were developed to identify patients earlier in the course of disease, so that correct DMARD therapy can be initiated quickly. These criteria use a point system that is weighted toward the number of joints that are inflamed. A total of 6 points or more is consistent with a diagnosis of Rheumatoid arthritis, and up to 5 points can come from the joint exam. Other parts of the criteria from which points are tallied up include elevated blood markers of inflammation, symptoms lasting longer than 6 weeks, and positive blood tests for either rheumatoid factor or anti-CCP. What is important to realize is the primary factor that establishes the diagnosis is the presence of inflamed joints.
Once the diagnosis is established, aggressive treatment with DMARDS should be started. These DMARDS are usually a combination of standard “old school” DMARDS such as methotrexate along with “new school” DMARDS, called biologics. These latter medicines are proteins that are used to specifically target the immune abnormalities that characterize rheumatoid arthritis.
Using this approach, it is possible to get the majority of Rheumatoid arthritis patients, seen early, into remission. While remission is a target that rheumatologists shoot for, the definition of remission varies depending on the remission-defining tool used. Nonetheless, they all have similar characteristics. There people who don’t respond. These patients are referred to as “non-responders.”
A non-responder is a patient with persistent disease despite current therapy. This may show up as persistent joint inflammation, elevated blood markers of systemic inflammation, or declining function.
A non-responder can be either primary… not responding right out of the chute, or secondary meaning they respond early on but then lose their response over time.
In either case, a switch in treatment is needed in order to prevent further functional decline and permanent joint damage.