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Rheumatoid Arthritis Program

The Massachusetts General Hospital Rheumatoid Arthritis Program is recognized internationally for its innovative research into this condition and state-of-the-art diagnostic and treatment services.

Improving Quality of Life for Rheumatoid Arthritis Patients

Our program's goal is to improve the quality of life for patients with rheumatoid arthritis. Through aggressive research efforts, we are trying to understand the mechanisms that cause the disease—and how to diagnose it and predict its progression. We hope these efforts will lead to new therapies and treatments that ultimately enhance patient care.

Recent years have seen important developments in treatments for this condition. By making an early diagnosis and managing medications effectively, we can often put rheumatoid arthritis into remission. Medications may still be quite effective in cases where the disease has progressed further, and we offer access to a variety of other services.

What to Expect

Our program is headquartered in the Yawkey Building on the main Mass General campus. Many of our services are also available at Mass General West in Waltham and our community health centers in Charlestown and Chelsea.

At your first appointment, one of our rheumatologists will review your history, perform a physical examination and decide which tests are necessary for diagnostic purposes. In its early stages, rheumatoid arthritis may be difficult to diagnose because symptoms may be very subtle and/or go undetected on X-rays or in blood tests. Our rheumatologists' experience with this disease helps them distinguish rheumatoid arthritis from other conditions and make earlier diagnoses.

A Personalized Treatment Plan

Your doctor will consider many factors when developing your personalized treatment plan such as your age, overall health and medical history along with disease progression. The earlier we can diagnose and start treating rheumatoid arthritis, the more we can lessen joint damage and impairment.

Most patients with rheumatoid arthritis benefit from use of medications such as:

  • Nonsteroidal anti-inflammatory medications (e.g. ibuprofen, naproxen)
  • Steroids (e.g. prednisone)
  • Disease-modifying anti-rheumatic drugs (DMARDs) (e.g. methotrexate, which has shown great promise in slowing bone erosions)
  • Biological response modifiers—including tumor necrosis factor (TNF) inhibitors—which suppress an important mediator of inflammation in rheumatoid arthritis. Other biologic response modifiers, such as CTLA4-Ig (abatacept) and rituximab, also target specific components of the immune system
  • Our physician staff is highly skilled at optimizing the effectiveness of medications to avoid the potentially severe side effects associated with some of these drugs.

    Besides medications, we provide access to other services at Mass General that can help address problems that may go along with rheumatoid arthritis (e.g. involvement in other systems, depression or, in advance cases, joint damage). These services include:

  • Physical and occupational therapy
  • Mind-body interventions at the Benson-Henry Institute for Mind Body Medicine
  • Orthopaedic surgery for joint replacement
  • Pulmonary, cardiac or other medical services

Most of our patients receive lifelong care at Mass General. We may see you as often as every week if you have acute difficulties or as infrequently as once a year if in remission. However, if you do not live in the area, we can co-manage care with your local physician.

Treating All Disease Stages of Rheumatoid Arthritis

Rheumatoid arthritis, a chronic autoimmune disease of unknown cause, is the most crippling form of inflammatory arthritis. Characterized by painful and stiff joints that may become swollen or deformed, it can also have devastating effects on the heart, lungs and other organs.

In addition to expert diagnosis, our program offers the latest treatments for all stages of this condition. Medical advancements over the past 30 years have greatly improved the outlook for patients with rheumatoid arthritis, particularly if treated early. As a result, many patients can go on with their lives with minimal or no limitations.

In patients with later-stage rheumatoid arthritis, we may coordinate clinical care with Mass General specialists in physical and occupational therapy, mind-body medicine and orthopaedic surgery. Regardless of disease duration, our goal is to help patients to reengage fully in their lives with minimal limitations.

Building on a Long Legacy

Mass General has an impressive legacy of research in rheumatoid arthritis. In the 1930s, Walter Bauer, MD, established the Rheumatology Program to bring basic scientists and clinicians together to study and treat this disease. In the 1990s and 2000s, investigator Brian Seed, PhD, was at the forefront of research that led to the development of tumor necrosis factor (TNF) inhibitors, a new class of drugs for rheumatoid arthritis.

Today, Allen Steere, MD, who laid the foundation for understanding Lyme arthritis (a tick-borne spirochetal infection) is using these insights in an effort to uncover causes of rheumatoid arthritis. His laboratory performs translational studies using samples from patients with rheumatoid arthritis and Lyme arthritis, a condition with many similarities, to:

  • Identify auto-antigens that lead to the immune response that causes each condition
  • Identify biomarkers (biological features) that will help us determine disease stage and aggressiveness of treatment
  • Develop better diagnostic tests

Additionally, Andrew Luster, MD, PhD, and Nancy Kim, MD, are studying the molecular events that lead to immune cell entry into the joint and resultant joint destruction in rheumatoid arthritis. The identification of these mediators may reveal new therapeutic targets for this condition.

Dr. Steere works with all of his colleagues in the Rheumatology Unit to provide our patients with state-of-the-art treatment for this disease. Our physicians are known for their ability to tailor their recommendations to the needs of the patient, taking into consideration personal preferences and family concerns. In addition, our clinicians' research work enhances their understanding of the condition—and their ability to treat it effectively.

Educating the Next Generation

As part of an internationally recognized teaching hospital, the Rheumatology Unit is committed to preparing the next generation of leading academic physicians, scientists and clinician-educators. Our fellowship program, affiliated with Harvard Medical School, entails intensive study of the clinical, diagnostic, therapeutic, pathogenic and research aspects of rheumatoid arthritis and other rheumatologic diseases. Internal medicine residents also gain exposure to rheumatoid arthritis patients as part of their general training.

 

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