By the time she visited Dr. Aileen Pangan’s clinic, the patient
arrived in a wheelchair. Rheumatoid arthritis — a chronic autoimmune
disease that can progress to permanent, debilitating bone and
cartilage damage — had destroyed her hips, both of which had been replaced.
Dr. Pangan, a rheumatologist and AbbVie’s executive medical director
in immunology clinical development, remembers the patient well because
the patient’s main concern was not for herself, but for her
19-year-old daughter who had recently been diagnosed with the same disease.
"Will she end up like me?" Dr. Pangan remembers the mother
asking her. "Will she also be in a wheelchair by the time she
gets to my age?"
With today’s therapies, Dr. Pangan says patients with rheumatoid
arthritis have a better chance at reaching remission. Yet not everyone
will reach this goal; many people will achieve only low-disease
activity, Dr. Pangan says. One in three people who have rheumatoid
arthritis alternate between relapse and remission regardless of
therapy, according to an Arthritis Foundation article.1
To improve those odds, scientists, health care providers and patient
advocacy groups continue to strive for a future where remission is
within reach for as many people as possible.
“If the disease is diagnosed and treated appropriately early, there’s
a better chance to get the disease under control and to reduce or
prevent irreversible joint damage,” says Ailsa Bosworth, MBE, founder
of the UK’s National Rheumatoid Arthritis Society, who has lived with
rheumatoid arthritis for nearly 40 years.
When people hear the word remission, the first disease that often
comes to mind is cancer. But remission is achievable in many chronic
diseases, including rheumatoid arthritis and other autoimmune diseases.
When physicians talk about remission in rheumatoid arthritis, Dr.
Pangan says, they’re referring to the absence or rare reoccurrence of
the signs and symptoms of inflammation, including joint pain, joint
tenderness and morning stiffness.1,2,3 Remission is the
primary treatment goal for patients with rheumatoid arthritis because
no therapy at this time can lead to a cure. Even if patients achieve
remission, the symptoms may come back.
“To people living with rheumatoid arthritis today, remission means
having prolonged periods of being able to return to everyday
activities, without having to think about and accommodate their
disease,” Bosworth says.
Multiple risk factors, including family history, genetic and
environmental factors may play a role in the onset of rheumatoid
arthritis. The immune system is activated against the joints and leads
to inflammation, which is critical to the progression of the disease.
Scientists have identified different pathways of inflammation which
may not be exactly the same for each and every rheumatoid arthritis
patient. This may be one of the reasons why patients have varying
responses to therapies.
“We continue to do research to better understand rheumatoid
arthritis and figure out what pathways we can target. Each patient
responds differently to treatments and we need more options that can
help patients achieve remission,” Dr. Pangan says.
Marwan Bukhari, Ph.D., FRCP, a rheumatologist in the U.K. whose
daily work involves deciding which medicine targets the right pathway
for patients, says that health care providers are now better at
eventually combating inflammation, but don’t have the tools to quickly
decide which medicine will work when a patient first visits the
clinic. He looks forward to the day when a biomarker can provide
information about how patients will respond to a given therapy.
“This would really help identify people with moderate disease or
whose symptoms are not obvious,” Dr. Bukhari says.
Dr. Pangan recalls another patient she saw in her practice.
The patient had lived with rheumatoid arthritis for many years. When
she finally got a treatment that worked for her and achieved
remission, she came back to the clinic with a powerful message. It’s a
message that has stuck with Dr. Pangan.
“She told me she never knew how sick she was until she got better.
She forgot what it meant to feel normal,” Dr. Pangan says. “With
greater awareness of rheumatoid arthritis and a focus on
advancing our scientific understanding of the disease, I am hopeful
more patients can get back to feeling normal.”