In the European Congress of Rheumatology (EULAR 2020), virtual. The views of doctors Aileen Pangan and María Celina De la Vega on the future of this inflammatory disease that more than 21 million people suffer worldwide

Rheumatologists specialists claim that innovation in treatments for rheumatoid arthritis (RA) produces a progressive increase in the remission rate , significantly improving the quality of life of patients.

“Throughout the history of disease treatment, we have had several milestones: from the appearance of the first disease-modifying treatments, followed by biological drugs (which allowed an abrupt change in the prognosis of the disease, avoiding or delaying disability), until today, where we have new small molecules for oral administration. These advances allow us to personalize more and more the treatments and increase access and adherence, ” Dr. María Celina De la Vega, vice president of the Argentine Society of Rheumatology (SAR), told

During the European Rheumatology Congress (EULAR 2020) , which was held virtually from June 3 to 6, among other innovations were presented, new results of one of the oral JAK inhibitor treatments available in the country. “We have conducted five clinical trials with Upadacitinib from different patient populations, compared to other previous treatments, and have noted that after three months with this new therapy, the remission rate reaches 30%. There is a significant improvement in what we can offer patients because in three months, three out of ten patients, in all the populations studied, can achieve remission of the disease and as follow-up continues, there will be more patients than They succeed, ” Dr. Aileen Pangan , rheumatologist, and director of Clinical Immunology and Development at AbbVie , assured .

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RA is a chronic autoimmune inflammatory disease of unknown cause that mainly affects the joints, although it can involve other organs of the body. The symptoms are installed little by little. Morning stiffness, joint pain, and swelling (hands, feet, knees, ankles, and elbows) dominate the picture; some also have generalized weakness, fatigue, and less frequent fever . Stiffness improves with movement and physical activity, and worsens with prolonged rest . It can affect anyone of either sex, although it is more common in women. In addition, although it is more common among older people, it can also affect children and young people.. If it is not treated in time it produces joint destruction, physical disability, and alteration of the quality of life.

The early diagnosis of the disease is essential and for this, before the first symptoms, a rheumatologist should be consulted to start treatment promptly. “When we start treating a patient with RA, our primary goal is for him to go into remission, that is, to have no more symptoms, such as pain and inflammation. In addition, when we do the imaging studies, we assess whether the disease is stopped and does not continue to hurt the bone, and therefore, will not cause subsequent deformities. ”, Explained the vice president of the SAR. In view of the new treatment options available, which make it possible to personalize the “therapeutic journey” of each patient, the specialist highlighted: “the remission rate, added to what we call ‘low disease activity’, which we can currently achieve in clinical practice, ranges from 50% to 60% ”.

The most concrete thing about RA is that it definitely impacts many aspects of patients’ daily life, it can even cause painful inflammation that can erode the bones and cause deformation of the joints, leading to disability in the patient (Shutterstock)

Currently, doctors and patients have many more options to tackle rheumatoid arthritis, evidencing a great advance in the main objective of treating this disease: achieving remission. “When we talk about remission, it is directly related to the daily experience. Can they get up in the morning? Can they go to work? Do you enjoy activities with your partner and / or family? Having few or no symptoms of the disease has a considerable impact on the quality of life. So, in our clinical trials we provide questionnaires to reflect if the patient feels pain, fatigue and / or has inflammation ”, explained Dr. Pangan.

To achieve this goal, in addition to therapeutic progress, specialists emphasize the importance of what they call: “shared decision”. “ The rheumatologist, from the medical knowledge, must present the patient with all the treatment options and thus, together, be able to choose according to their own characteristics, which is the most indicated. In this way, when the patient is responsible for her treatment and commits herself, we obtain better results ”, the specialists agreed. And Dr. De la Vega added: “There are studies that show that when choosing a treatment, many patients opt for those medications that can be administered orally and less frequently.”

After choosing the first treatment, ” according to our guidelines, if the patient is active, we should evaluate it for one to three months and define whether to continue or modify the treatment, according to the objectives achieved, ” explained Dr. De la Vega. “In the future, as we gain a better understanding of the disease and the differences between patients, we hope to be able to predict the best first treatment for each patient, based on how they are doing and on laboratory studies. Thus, they can achieve the treatment objectives much faster, “concluded Dr. Pangan.

The great scientific innovations promoted by science are useless if they are not accompanied by accessible treatments and therapeutics that improve the quality of life of patients. There is a genetic predisposition to suffer from RA, but there are also environmental issues that can affect the development of the disease (Shutterstock)

Rheumatoid arthritis and COVID-19

During the current outbreak of coronavirus COVID-19, special questions and anxieties of patients with rheumatologic diseases arise, especially those treated with immunosuppressive drugs such as biologics, JAK inhibitors, steroids, and conventional disease-modifying antirheumatic drugs ( DMARDs ). .

According to world reports, until now, patients with rheumatologic diseases would not have a higher probability of COVID-19 infection, or an increased severity of infection . Autoimmune diseases such as rheumatoid arthritis have various comorbidities such as diabetes, heart disease, kidney failure, among others, which do represent risk factors for this infectious disease. “It has been reported that patients treated with immunosuppressants would also not present an increased risk, therefore, they should not abandon their treatments or make unilateral decisions. If you have any concerns regarding your treatment, you should consult your doctor, “explained Dr. De la Vega.

International guidelines, such as the one published by EULAR, recommend that you do not stop visiting the rheumatologist if the routine consultation is essential, if it can be safely delayed or opt for other remote care alternatives .

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With 45 minutes of exercise per week arthritis is controlled – Arthritisco · June 17, 2020 at 7:28 pm

[…] You can read: New treatments for rheumatoid arthritis allow more and more patients to achieve remission […]

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