WebMD 5: Rheumatoid Arthritis
Our expert explains rheumatoid arthritis and what's ahead for treatment.
3. Besides medication, what else works?
In almost any pain or arthritis study, about 20% to 30% of patients have a modest response to a placebo, which means the expectation of improvement can lead to changes in disease activity. And there actually is physical and laboratory evidence that people are improving, so there must be a biology to it that we don't understand.
It's really important to maintain range of motion and stay physically active if you have any chronic disease and especially a disease of the joints such as RA. Swimming is a great exercise. Using elliptical machines rather than running and pounding the pavement is another example of getting a good aerobic workout without having high impact on inflamed joints.
4. Is it possible to get pregnant with RA? Can I pass RA on to my child?
Women with RA can certainly become pregnant, and pregnancy can induce remission in a large percentage of women -- about half to three-quarters. Subsequently, about one to two months after delivery, those women almost always have a return of the disease or a flare. Nobody really understands why. There are some theories about how the immune system in pregnant women gets modified to prevent rejection of a fetus, and maybe that's responsible for putting the disease into remission.
We always try to minimize drug exposure during pregnancy. There can be some risks related to certain RA medications (such as methotrexate) during pregnancy, so we usually recommend that women be off these medications for six months or so before conceiving.
5. What new treatments do you see coming out in the next five to 10 years?
The most recent RA drugs, the biologics, have to be injected, so there is now a push to find oral pills that mimic the effects of these drugs. And there's considerable interest in personalized medicine -- to try to look at the genetic makeup of a person with RA, so that rather than doing guesswork to find the right combination of medicines, we'll be able to predict treatment based on someone's genes.
Another area is trying to understand when RA actually begins. There's a lot of evidence that the evolution of RA is something that occurs over many years. And we would like the ability to intercede early on in the disease or even before people have symptoms.