In this MD Newsline exclusive interview with rheumatologist Dr. Maggie Cadet, we discuss Dr. Cadet’s treatment strategy for rheumatoid arthritis. We also discuss the importance of helping patients understand and prevent the complications of rheumatoid arthritis.
What is your treatment strategy for rheumatoid arthritis, and how is it tailored to each patient? How do these treatments work? How do you decide when to switch treatments?
Dr. Maggie Cadet:
“First, I emphasize to my patients with rheumatoid arthritis that any treatment at all is better than no treatment. Our arsenal of medications includes steroids, used as a bridge therapy and for disease flares, and our more aggressive treatments, including disease-modifying antirheumatic drugs (DMARDs) and biologic therapies. These treatments may be given as pills, injections, or infusions and work by targeting cytokines that increase inflammatory processes in the body.
Every patient is unique, and I take into account their medical history, including other comorbidities. Then, I talk to the patient about the risks and benefits of each medication, and we choose a regimen that ultimately will work best for the patient.
For example, methotrexate is a DMARD and cornerstone therapy for rheumatoid arthritis. However, if my patient is a young female who is trying to get pregnant or a male who wants to participate in family planning, I won’t use methotrexate because it’s teratogenic. Additionally, if my patient likes to drink alcohol, I won’t use methotrexate because it can affect the liver, especially in combination with alcohol.
Also, some biologic therapies may carry some risk of malignancy. So, for my patients with a history of malignancy, I have to be careful about which biologic therapy I recommend.
Finally, I consider how well my patients will adhere to treatment. Will they be able to take a pill daily, or would they prefer to take their medication in the form of a weekly or monthly injection? Fortunately, there are many biologic options available for patients, such as TNF-inhibitors, IL-6 inhibitors, other co-stimulatory inhibitors, etc.
And, combination therapy is usually more effective for most patients than monotherapy. So, even if a patient’s disease isn’t adequately controlled on one medication, you can do combination therapy or step-up therapy.”
Is there anything else you would like to speak on that we have not already covered?
Dr. Maggie Cadet:
“I want to reemphasize that it’s really important for patients to understand that rheumatoid arthritis is not just a joint disease. Rheumatoid arthritis can affect so many other organs. For example, we know that cardiovascular morbidity and mortality are highly associated with active rheumatoid arthritis. So, I like to emphasize to patients that we’re not just treating their joint disease; we’re preventing other organ involvement.
Finally, I also want my patients to care for other areas of their health that contribute to heart disease, like weight, blood pressure, dietary cholesterol, and exercise. I recognize that social determinants of health may affect my patients’ ability to care for these parts of their health, but I work with them to help them do the best they can.”
Responses have been condensed and lightly edited.