‘THINGS THAT MAKE YOU GO HUH?’
Brett Hellman: So, you may notice some sniffles, coughing, cracked vocal around as I have been battling a cold this past week. I'm not going to lie, it’s been kind of a struggle getting out of bed. I just don't feel like myself and being really honest, I feel like I got hit by a truck. So in all of this sick-haze of mine, it actually got me to thinking...what happens to people who are sick like this and feeling crummy and it never goes away. People with chronic diseases, I mean, what's it like to live with a chronic disease where you're not feeling your best self 24/7.
Are there ways for people with chronic diseases to actually feel better? And if it’s a chronic disease, does that mean it can't be cured? What does remission look like for someone with a chronic illness?
Well, it just so happens I have a colleague here with me who I used to work with and I love dearly, may I add. Who is a practicing rheumatologist and truly understands this topic. I was lucky enough to catch her in between a bunch of important meetings. So, with a few minutes to spare. Let's get started on this very special edition of "Things That Make You Go Huh?"
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Brett: Okay, folks, I'm very excited about our next guest today. I know this person very well. And so, let's get to it. Can you tell us who you are and what you do?
Aileen Pangan: I'm Aileen Pangan, I’m a rheumatologist here at AbbVie and I'm the Executive Medical Director in Immunology Clinical Development. I oversee a team of sixteen physicians and PhDs who oversee clinical trials in rheumatology, dermatology, and gastroenterology.
Brett: Awesome, that sounds very exciting. Let's get right to it. So, I think I want to start out with just the word "remission." So when I hear about remission, the first thing that comes to my mind is cancer. So I want to know what remission means for diseases like cancer or other chronic diseases.
Aileen: When physicians and patients talk about remission, it’s really when a patient no longer has symptoms and often times, the physician's physical exam does not reveal any evidence of disease or sometimes imaging in the laboratory test also show that the disease is no longer manifesting itself. But it doesn't represent a cure, right. It’s a stage where sometimes a disease might come back, like a flare or a reoccurrence.
Brett: So I'm a little confused, so does that mean that you no longer have the disease. Can you clarify?
Aileen: So, when a treatment results in a cure; it means you’ve completely removed from the body what is causing a disease. Like when you have an infection and I give you an antibiotic, I cure the infection and you’re symptom-free. In a chronic disease like rheumatoid arthritis, despite the availability of many treatments, we have not gotten to a point of a cure where we completely remove what's causing the disease. So the most we can do right now is get a patient into remission where we successfully control the manifestation of the disease.
Brett: You bring up rheumatoid arthritis. For myself, who is a little bit scientifically challenged, can you please help to explain what exactly is rheumatoid arthritis?
Aileen: When you hear the word arthritis, that means there is inflammation in the joints. So rheumatoid arthritis is actually a disease that primarily manifests with patients having pain and swelling in certain joints of the body.
But in addition, it causes systemic inflammation, meaning you can also have inflammation in other parts of your body. So typically, a rheumatoid arthritis patient comes to a physician because they can no longer use, for example, their hands because their joints are so painful. They sometimes feel very tired and they can no longer do the work that they normally do. So that’s a typical rheumatoid arthritis patient.
Brett: Okay, that’s actually really helpful. So then, I guess that brings me to: What does remission look like with rheumatoid arthritis then?
Aileen: Well, remission means they come to my clinic and say my joints no longer hurt me. I can now do the things I used to do. I no longer feel so tired. And so, they are almost back to what they were before they had the disease.
Brett: So, this may sound silly, but how often does that happen? Do RA patients generally go into remission?
Aileen: If we are talking about the complete remission stage that I just described, the fact is not a whole lot of patients can get there. Even with the availability of all the treatments that we have in rheumatoid arthritis. At most, some people go into low-disease activity but it still is a challenge to get all our patients to a complete remission state.
Brett: So how can get there? How can we get to full remission?
Aileen: That is exactly what physicians in clinical development like me are very passionate about. We continue to do research to better understand rheumatoid arthritis. And figuring out what pathways we can target so that we can offer more options to patients. Because as we know, not one drug would work for every patient.
Brett: Can you talk a little bit more about that? Because that's a little hard for me to understand. So not all patients respond the same to the same medicine?
Aileen: In rheumatoid arthritis, what most people don't understand is that just because you have the same disease doesn't mean every patient is the same. There are different pathways of inflammation that are prominent in certain patients and this leads to a variety of responses to the different drugs.
Brett: So, you're a rheumatologist, can we talk a little bit this? What did remission look like in your practice?
Aileen: Brett, I remember a patient I saw in practice and she's had rheumatoid arthritis for many years. When we finally found the right treatment for her, she gave back to clinic and what she said to me was very powerful. She said, "I never knew how sick I was until I got well. I had forgotten what it meant to be normal." And so, for me, that was very satisfying.
Brett: So, do we know what causes rheumatoid arthritis?
Aileen: After many years of research, we have understood multiple risk factors as to why patients get the disease. But it’s really not clear yet as to what is that one event in the body that triggers a patient to have RA. We understand that family history, genetic factors, and environmental factors, even, may play a role. But no one really fully understands what causes a patient to have RA.
Brett: This has been around for a really long time. So my question is, how has treatment evolved over those many years?
Aileen: Well, Brett, I think the best illustration of how treatment has evolved in this disease is something that I remember from when I was in practice. I had two patients, a mother and daughter. And the mother has had RA for a long time when I first met her. She actually comes to my clinic in a wheel chair. She's had both hips replaced, and her fingers were so deformed. When I diagnosed her 19 year-old-daughter with rheumatoid arthritis, her main concern that she voiced to me was, "Will my daughter end up like me?" I think she was referring, "Will she also be in a wheel chair by the time she gets to my age?" And I looked at her and her daughter and I said, "You know what, I think she's going to have a different future because in this day and age, we have treatments for rheumatoid arthritis that can hopefully control her disease and prevent her from getting the same joint destructions that she had."
Brett: What do you envision for the future of people living with rheumatoid arthritis?
Aileen: Our hope is that, in the future, we will be able to tailor the treatment of these patient. As I said earlier, right now, not one drug works for every patient. We don't have the right tools to figure out what is the right drug for the right patient. So, I envision a future where RA patients have a variety of options to address their disease. And rheumatologists having a way to identify which drug is the correct one for which patient.
Brett: Thank you so much for your time today, Aileen. I loved talking to you today. This is my favorite part – not – of the podcast where I do my own knowledge check to see what I learned in today’s discussion.
I am going to try and hit on three points to please my producer who is sitting right next to me listening. So, the first point that I learned today is what remission means. I think from a high-level standpoint it means the disease is not manifesting itself but it is still not cured?
Brett: Yay! One for one. The second thing I think that I would hit on is that in RA, the treatment goal is to get patients into remission.
Aileen: Two points for Brett.
Brett: Woohoo! Moving on to number three, which is that not all drugs work for all people the same way so our work is to figure out to find the right option for the right patient? Does that make sense?
Aileen: Yup, that is certainly the future.
Brett: Awesome, thank you so much for your time today.
Aileen: You're welcome!
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