When is it just too late to bother treating Rheumatoid Arthritis?

By Dr Irwin Lim, Rheumatologist

I feel saddened when a patient walks into my office with hands like these. Such damage.

As rheumatologists, we probably feel impotent when faced with this sort of late disease. Joint and bony destruction has occurred. There is obvious deformity that cannot be reversed. We've missed the boat.

I wonder how many doctors and health professionals may take the attitude that it's just too late to be able to treat.

While I of course agree that the deformity cannot be reversed, any inflammation should still be treated as best we can. We can be surprised by what can be achieved by reducing pain and swelling. Even small gains may lead to useful gains in function. Improved quality of life.

These hands belong to an elderly, non-English speaking lady. She has had 30+ years of essentially untreated disease. She was just too afraid to take the "powerful" drugs and had heard too many stories about the bad side effects.

She is now on low dose Prednisone with some Methotrexate (the Methotrexate is acting as a medication that will help reduce the dose of steroid required, a steroid-sparing agent). This combination has helped her pain, reduced the amount of swelling around the joints and reduced the inflammatory markers measured in her blood.

While she still cannot grip a mug and still struggles to walk due to the corresponding deformity in her feet, knees, ankles and hips, she reports through her son that she can do more. She's grateful for some reduction in stiffness and for the minor increase in her ability to get out of a chair.

Rheumatologists focus on the Window of Opportunity and this concept highlights the need to treat rheumatoid arthritis as early as possible with aggressive treatment as needed.

These hands show you why.

Sometimes, we do miss this window of opportunity and the patient presents late. Even then, it's not too late to help.