Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation and pain in the joints. While there is currently no cure, huge strides have been made in recent years towards more effective treatments that put RA into remission. New medications, improved screening, and a better understanding of the disease pathology bring hope that a cure may be on the horizon.
What is rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disorder where the immune system attacks the body’s own tissues, specifically the synovial membrane that lines the joints. This causes swelling, pain, and eventual joint damage and deformity. It is a progressive disease that can lead to significant disability if left uncontrolled. Key features of RA include:
- Joint swelling, pain, stiffness, and loss of function
- Symmetrical pattern – both sides of the body affected
- Morning joint stiffness lasting over 30 minutes
- Fatigue, fever, and weight loss in some patients
- Joint deformities over time
RA affects about 1% of the population worldwide. It can begin at any age but most commonly starts between ages 30-50. Women are affected 2-3 times more than men. The exact causes are still unknown but believed to involve a combination of genetic and environmental factors.
What treatments are currently available?
While there is no current cure, treatment options have expanded dramatically in the last 20 years. The goals of treatment are to reduce inflammation, relieve pain, slow or stop joint damage, and improve physical function. Some current treatment approaches include:
Medications
Disease Modifying Anti-Rheumatic Drugs (DMARDs): This class of medications work to suppress the overactive immune system targeting the joints. They help reduce inflammation, prevent damage, and slow disease progression. Examples include methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide.
Biologics: A newer class of DMARDs, these injectable drugs specifically block inflammatory proteins called cytokines. Examples are etanercept, infliximab, adalimumab, rituximab, and abatacept.
JAK inhibitors: The latest oral DMARDs that block enzymes called janus kinases (JAK) involved in the immune response. Examples are tofacitinib, baricitinib, and upadacitinib.
Corticosteroids: Powerful anti-inflammatory drugs like prednisone used short-term to quickly reduce inflammation during flares.
NSAIDs: Non-steroidal anti-inflammatory drugs like ibuprofen used for pain relief.
Surgery
For severe joint damage that causes disability, surgery may be done to repair, realign, or replace damaged joints. Common surgeries include synovectomy, joint fusion, and total joint replacements.
Lifestyle approaches
Complementary therapies and lifestyle changes may help reduce symptoms including:
- Low-impact exercise
- Physical therapy
- Joint splints or braces
- Balanced diet
- Stress reduction
- Quitting smoking
What progress has been made towards better treatments?
Thanks to expanded knowledge of RA disease mechanisms, many new and improved treatments have been introduced, especially in the last 20 years. Some key advances include:
Earlier treatment
Studies show that starting treatment immediately once RA is diagnosed leads to better outcomes. The old standard of waiting for damage to occur before treating is no longer recommended. Early intensive treatment helps minimize irreversible joint destruction.
New oral DMARDs
Traditional DMARDs like methotrexate were effective but had troublesome side effects. Newer oral options like JAK inhibitors offer similar benefits with fewer side effects and more convenient dosing.
Advanced biologic DMARDs
The advent of biologic medications revolutionized RA treatment by specifically targeting inflammatory proteins. Ongoing research is producing biologics with higher efficacy and safety profiles.
Improved screening
Better diagnostic tests allow doctors to identify RA earlier, before joint damage occurs. These include blood tests for inflammatory markers and antibodies found in RA.
Combination therapy
Using two or more DMARDs together has been shown to be more effective that single drug therapy. This helps maximize inflammation reduction without increasing doses and side effects.
Treat to target approach
Doctors now use “treat to target” strategies where medication is adjusted based on objective disease activity measures. This results in tighter control of inflammation long-term.
What future treatments are being researched?
Current RA research is focused on gaining an even better understanding of the autoimmune process and finding new pathologic targets to shut down inflammation more selectively. Some promising future directions include:
Advanced biologics
Next generation biologics are being developed that may improve specificity, decrease immunogenicity, allow oral administration, and maintain effectiveness longer-term.
Gene therapy
Introducing new genes or editing disease-related genes may someday allow correcting the immune dysfunction in RA at its root cause.
Stem cell therapy
Using stem cells to regenerate damaged joint cartilage and modulate the autoimmune response shows potential based on early studies.
Precision medicine
Customizing treatment by matching medications to patients’ genetic makeup and disease features could improve effectiveness and minimize side effects.
New targets
Other processes like B cell activation, osteoclast activity, and the inflammasome are being investigated as potential new drug targets.
How close are we to a cure?
While a definitive cure is not available yet, the outlook for better management and potentially remission for RA is promising thanks to recent advances. Some key points:
- Complete disease remission is achievable now with early aggressive treatment in some patients.
- Ongoing research and rapid development of new medications could lead to higher remission rates.
- A better understanding of RA pathology brings hope for more targeted, gene-based cures in the future.
- Realistic estimates put a definitive cure at least 10-20 years away still.
In summary, while full cure is still years away, progress is accelerating. Patients diagnosed today have access to treatments beyond what was imagined even 10 years ago. Continued medical advances offer hope that rheumatoid arthritis may someday become a curable disease.