What Lies Beneath

A boy watches a scary movie and covers his eyes, hoping to shield himself from terror. A baby plays peek-a-boo, unsure that the person in front of her will ever reappear. What do these scenarios have in common? The belief that if you can’t see it with your own eyes, it doesn’t exist.

As we mature, we realize that this just isn’t true. You may not be able to see the slow progression of a plant from seed to sapling, but you accept that it transpired. Things that happen out of sight are just as real as things occurring right in front of you.

This is important to remember when thinking about a chronic, progressive disease like rheumatoid arthritis (RA), where so much may be unseen. Symptoms may come on slowly, over the course of weeks, months or even years. They may get better, and then worse. A person may not “look” sick, but the pain they feel is entirely real.

According to Aileen Pangan, M.D., a rheumatologist and executive medical director, immunology, AbbVie, understanding the reality of what this means is essential to improving patient’s lives.

“In any kind of chronic disease, ‘progression’ means that the disease is advancing, either affecting more parts of your body, or having a more severe impact,” Pangan says.

“For patients with RA, that means you are no longer just having inflamed joints, now the disease is causing erosion of the bones leading to irreversible damage and loss of function of your joint.”

While the chronic inflammation of RA typically causes joint swelling and pain, this bone erosion may not lead to specific symptoms that patients can readily recognize – until the damage has evolved to the point where it is causing deformity and/or limited movement of the joint.

In other words, even though the patient can’t see it, the disease can cause changes in the body that have a lasting impact.

According to Pangan, the best chance of controlling the disease and preventing or stopping progression in its tracks is a strong patient-physician partnership. Unfortunately, it can sometimes take a while for a patient to even get in front of a rheumatologist.

“At first, patients may try to address symptoms with over-the-counter remedies, not knowing that they actually have a chronic disease. It’s only when symptoms persist that they might finally mention it to their primary care physician, who may or may not suspect RA,” Pangan explains. “Even if they get a referral to a rheumatologist, it can sometimes still take months before they are actually seen, diagnosed and adequately treated.”

Getting the right diagnosis is the first step, but an ongoing partnership is essential, as appropriate management of the disease is a work in progress.

“There needs to be a constant assessment of whether the current treatment is working, or if there is a need to change therapy,” Pangan says. “As research has advanced our understanding of RA and delivered innovative therapies, we’ve reached a point where many patients can attain low disease activity or a remission-like state. Rheumatologists and their patients have more ways than ever of achieving their treatment goals.”