Julie Brunner’s vacation to France a decade ago wasn’t all baguettes and berets—after a week there, previously manageable chronic pain in her shoulders had spread rapidly throughout her body. Soon it was physical torture to perform the simplest tasks.
“I had difficulty even zipping my pants—every joint hurt,” she recalls. Shortly after returning home, she was diagnosed with rheumatoid arthritis, a frightening diagnosis with, at the time, uncertain long-term prospects. “There are people in wheelchairs because of rheumatoid arthritis,” Brunner adds.
Rheumatoid arthritis is an inflammatory disease in which the immune system attacks the body’s own joints (as opposed to osteoarthritis, which is the wearing of cartilage over time). While just 2 percent of arthritis cases are rheumatoid, it’s a condition found far more often in women than men. The inflammation the disease provokes leads to swelling and stiffness, potentially progressing to bone erosion and joint deformity. It can also have adverse effects on other organs, such as the lungs and eyes.
“Prior to 1990 or so, about 25 to 35 percent of RA patients were disabled within five years,” says Park Nicollet rheumatologist Dr. Peter Kent. Treatment that was available included drugs that slowed down how fast certain cells divide, including some of the immune cells that can cause inflammation. But there were drawbacks.
“The older medications don’t act on one specific aspect of the immune system—they can have broader effects,” Kent says. “For example, some cause the thinning of hair, because hair is made of faster-growing cells. So they affect inflammation cells but they also can affect a whole range of other systems.”
Recent years, though, have seen the development of biologics: medications that target only the proteins that cause inflammation, lessening the impact on other biological processes. Some doctors have made an analogy to “smart bombs” that leave significantly less collateral damage.
“The newer medications have targeted central immune triggering reactions that occur in patients with RA and block them by using designer proteins that stop or blunt inflammation,” explains Park Nicollet rheumatologist Dr. Scott Glickstein.
This precision has worked wonders for many patients, though biologics aren’t necessarily right for everyone—some patients still benefit from the older medications, or mixing them with biologics.
“With this disease, part of your immune system is being too active—so you want to push back, but not so much that the immune system can’t defend against infection,” Kent says. “All of these medications carry some infection risk. While RA itself can be devastating if untreated and can lead to disability, you constantly have to weigh out the risks and the benefits.”
Still, treatment of RA is an area in which medical practitioners see even more good news on the horizon. It’s a frontier where drug companies are competing to create the next innovation, and their trials have become more inventive and, by all accounts, are opening the path for more major breakthroughs ahead. “There are some studies looking at people who have a high risk of getting RA,” says Kent. “In the future, therapies may be developed to prevent the onset of RA in high-risk individuals or those carrying certain genes that greatly increase their risk. If people know they have a strong chance of getting RA, it may be worth taking something preventative.” And while the first generations of biologics are given intravenously or through injections, newer ones can be taken orally, making treatment easier and more convenient for patients.
For Julie Brunner, biologics have been the dramatic answer to managing her disease. Since beginning periodic intravenous treatments of the biologic drug Remicade, the 67-year-old has experienced almost no pain. “I walk every day—I try to get in my 10,000 steps. I do yoga and work out with a trainer. I do a lot of hiking. I try to stay active, because now I can.”