Diagnostic and Treatment Practices in Rheumatoid Arthritis

At AAPA 2017, Benjamin Smith, PA-C, DFAAPA, Florida State University College of Medicine, discussed the tremendous advances in both treating and diagnosing rheumatoid arthritis. About 15 years ago, the CCP lab tests came about, which certainly help with specificity for diagnosing rheumatoid arthritis (RA).

Smith pointed out that clinicians need to focus on diagnosing and treating RA early and sometimes aggressively when making diagnoses. “We know that those we treat early have the greatest likelihood of doing well in terms of prognosis.”

While RA more predominantly affects women, generally the onset of disease can be very similar for men and women. But, for the condition itself, people may present differently — some people may have a sudden onset of symptoms, yet for other patients their symptoms may only appear over time. “This makes it a little harder to diagnosis, but we should always have that high level of suspicion when someone presents with inflammatory joint symptoms,” Smith said.

Smith explained that the new class of medication, biologics, has really made a change in the way we approach RA. Traditional disease modifying medications such as methotrexate still have a place, but biologics for those who don’t get good disease control with methotrexate or these combination medicines have been a great tool to treat RA. “In some ways, they are cleaner perhaps than the traditional disease modifying medications, but they are powerful medications with immunosuppressing properties, so we have to monitor them closely over time.”

Because there are many types of biologics or small molecules now, clinicians are very selective in how they choose them based on a person’s comorbidities — and patients’ choice as well.