Rheumatoid Arthritis: An Overview

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Rheumatoid Arthritis:  An Overview




Guest:  Dr. Jim Oates – Rheumatology & Immunology

Host:  Dr. Linda Oates – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Jim Oates, who is Associate Professor of Rheumatology here, at MUSC.  Dr. Oates, let’s talk about a very common form of arthritis, rheumatoid arthritis.  How is rheumatoid arthritis different from more common forms like osteoarthritis?


Dr. Jim Oates:  Rheumatoid arthritis involves an inflammation of the capsule that lines the joint, whereas osteoarthritis involves inflammation, actually, in the cartilage itself.  So, with rheumatoid arthritis, you’ll see more swelling of the joint.  You’ll see more warmth of the joint.  You’ll get stiffness in the morning, often times more than an hour.  And the problem with rheumatoid arthritis, that we see, that we’re trying to target with our therapy is that it can cause destruction of a joint at a much more rapid pace than osteoarthritis can.


Dr. Linda Austin:  Are there particular joints that are susceptible to rheumatoid arthritis?


Dr. Jim Oates:  Almost any joint.  I can tell you, probably, more quickly which joints aren’t involved.  The back, except for in the very upper part of the neck, is pretty much spared in rheumatoid arthritis, but almost any joint is involved in rheumatoid arthritis.  One differentiating joint between osteoarthritis and rheumatoid arthritis is that last knuckle on your finger that’s closest to the nail, which is involved in osteoarthritis, rather than rheumatoid arthritis.


Dr. Linda Austin:  I know rheumatoid arthritis can occur in children.  What’s the youngest child you’ve ever seen with RA?


Dr. Jim Oates:  There is a separate entity, what we call chronic juvenile arthritis, or juvenile idiopathic arthritis, which can occur in somebody as young as one and half or two.  The course of that disease is very different from what we see in adults.  Often times that can remit over time or involve just a few joints, whereas in adult rheumatoid arthritis, we see involvement of many joints, often the wrists and the hand joints, whereas in the juvenile version, in the younger girls anyway, it can occur in maybe one or two joints.  The children that have involvement of more joints, they tend to occur at an older age, and that might be in the teens.


Dr. Linda Austin:  How do you treat RA?


Dr. Oates:  There are lots of potential therapies.  And that means we haven’t mastered it yet.  But a standard of care for rheumatoid arthritis is a drug called Methotrexate.  This is a chemotherapy drug that is used in much lower doses in rheumatoid arthritis than it is used to try to treat cancer.  It’s dosed once a week and it is relatively effective.  Patients who don’t respond to that therapy, we have a whole host of new therapies now that we can treat rheumatoid arthritis with.


Dr. Linda Austin:  So, it sounds like it’s a pretty promising time for RA patients, if there are a lot of new drugs coming out?

Dr. Jim Oates:  It really is.  If you look in a waiting room in a rheumatology practice now, compared to 10 or 20 years ago, you’ll see a dramatic difference.  Ten or twenty years ago, you would see patients in wheelchairs, with chronic deformities and great disability.  Now we have drugs that when added to Methotrexate, which is our standard of care, really can prevent joint destruction and allow people to go back to work in a way that wasn’t possible before.  They are not 100 percent.  Patients may have some joints that are still active.  But, between now and a decade ago, it’s night and day. 


Dr. Linda Austin:  Do we have any clinical trials going on here for RA at MUSC?


Dr. Jim Oates:  Yes, we do.  There are several therapies that are already FDA approved for rheumatoid arthritis.  But further research trials are going on to look at side effect profiles, to look at how patients may respond to these drugs, if they’ve failed other drugs.  There is a good deal of those trials going on at MUSC.


Dr. Linda Austin:  Dr. Oates, thank you so much for talking with us today.


Dr. Jim Oates:  Thank you.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.

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