Arthritis: An Overview
Guest: Dr. Jim Oates – Rheumatology & Immunology
Host: Dr. Linda Oates – Psychiatry
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
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.
Linda Austin: Are there particular
joints that are susceptible to rheumatoid arthritis?
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
Linda Austin: I know rheumatoid
arthritis can occur in children. What’s
the youngest child you’ve ever seen with RA?
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.
Linda Austin: How do you treat RA?
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.
Linda Austin: So, it sounds like it’s a
pretty promising time for RA patients, if there are a lot of new drugs coming
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.
Linda Austin: Do we have any clinical
trials going on here for RA at MUSC?
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.
Linda Austin: Dr. Oates, thank you so
much for talking with us today.
Oates: Thank you.
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