Friday, 1 February 2013

The Most Exciting Time in the History of RA

The treatment of inflammatory arthritis has changed dramatically over the past 15 years and the talk I am blogging about is a great introduction to anyone with a new diagnosis.  

I was there at this presentation and have recommended it to many people since.  It's a good way to get a basic understanding of inflammatory disease and the treatments.  The mechanisms of action of the various treatments are well described. 

Dr Edward Keystone is a dynamic speaker and also Director of The Rebecca MacDonald Centre for Arthritis and Autoimmune Disease  - a center devoted to research into genomics, therapeutics, and outcomes in autoimmune inflammatory joint disease and osteoarthritis. It is part of  Mount Sinai Hospital in Toronto.

Dr. Keystone gave a talk in 2010 that is still relevant, even though many more drugs have been introduced in the years since then. The title of the talk was The Most Exciting Time Ever in the History of Rheumatoid Arthritis and used to be found on the site of The Arthritis Society

                                   And it's even better now

It's a long talk and he starts speaking 10 minutes in after the intros.  He describes what RA is and makes the scientific information about biologic drugs very understandable. It would really help someone faced with a treatment decision or a new diagnosis of inflammatory arthritis.

Here are some of the points that he made:

If the joints are swollen they will sustain damage

Aggressive early treatment is important

RA feels like a fire in the joints.   (In this post you can see I described the rheumatologist as a fireman)

RA is a medical emergency.

Tight control is the best strategy. Adjust therapy frequently to reach the target, which is now remission.

You start with methotrexate ...

                                Fun Wow Methotrexate injection time

This talk is one of my favourite resources.  Dr Keystone's enthusiasm is infectious.

I had hand surgery just before I wrote this blog post.  I needed the surgery because of early damage that happened before I was diasgnosed and had good treatment.

There were no fun pictures to see under hand surgery. (they were informative but not for everyone) This is not too bad though.

I was going to blog about wrist fusion but I am not sure how many people are interested in something that is done less often now.  At the moment I am taking the ostrich stance on it.  It's easier to stay calm that way.

I did not know ostriches really did this.

** Here is another excellent resource for a patient facing a treatment decision.  It's a blog post by Dr. 
Shashank Akerkar called Time, tide & inflammation waits for nobody...
He followed that up with another that is very informative History of Rheumatoid Arthritis that shows the pace of progress in treatment.

So, the doctors weigh in, and seem to agree on the best course of action. It worked for me - with good treatment I worked until I retired. Honestly, it was no picnic but it was a goal that meant a lot to me.


  1. Thanks for sharing Dr. Keystone's talk. I have two comments. The first is that MRIs and ultrasonography are proving to be much more effective at detecting sub-clinical inflammation than only the rheumatologists' physical exam. There are many research studies published to support this claim. Second, even when inflammation appears to be reasonably controlled, the effects of having RA/RD can continue to be disabling. This aspect of remaining joint stiffness, tenderness, pain, and fatigue doesn't seem to be understood YET : ) Happy Rheumatoid Awareness Day !!! I appreciate your advocacy and this blog.

    1. Helen, It's so encouraging to hear that someone is enjoying the blog. I am trying to keep improving and to be interesting.

      I really agree with you about the sub-clinical inflammation being hard to detect by physical exam, and about damage continuing to occur even when inflammation seems reasonably controlled. This was what led me to push for a biologic, and even with the biologic I have gradually lost the use of a finger joint in the last 2 years. It would be great to see more progress in this area.

  2. I was there at that talk and often link to it. It's so hopeful

    Hope the hand's healing well.

    1. I thought the topic was really appropriate for Rheumatoid Awareness Day. And it takes a few years for Dr Keystone to go out of date. He offers a lot of hope

  3. Dr. Keystone has been my rheumatologist for years. He diagnosed me and when we moved to Alberta set me up with a rheumatologist there that he felt I would get along with. When I returned to Ontario and was unhappy with local medical options he took me back on as a patient. I travel 4 + hours by train to see him about twice yearly. One of the things I like best about him is his positivity. He always has a plan, listens well and dispenses hope along with medication.