Clinicians at Brigham and Women’s Hospital’s (BWH) Center for Arthritis and Joint Diseases offer comprehensive care—diagnosis, treatment, and management—for patients with rheumatoid arthritis and other rheumatic diseases. From its origins as the Robert B. Brigham Hospital, the first teaching hospital in this country entirely devoted to treatment of symptoms and causes of rheumatoid arthritis and related diseases, the Center has become a focus for pioneering research, innovative therapeutics, and world-class care for arthritis sufferers.
Rheumatoid Arthritis Treatment: Early intervention
Patients with rheumatoid arthritis symptoms, especially those who have recently been diagnosed, as well as patients with undiagnosed arthritis or undifferentiated systemic rheumatic disease, may benefit from referral to the Center for Arthritis and Joint Diseases for diagnosis and early treatment. Center Director Jonathan S. Coblyn, MD, BWH Director of Clinical Rheumatology, says it is critical that patients be evaluated for rheumatoid arthritis treatment as soon as possible after diagnosis. MRI demonstrates clearly that many patients have significant joint erosion and damage before changes are evident on x-ray, and often in advance of symptoms that correlate with the severity of the damage. Dr. Coblyn says, “We believe that in the absence of contraindications, every rheumatoid arthritis patient should be on a DMARD (disease modifying antirheumatic drug) ideally within three to six months of diagnosis.”
Rheumatoid Arthritis: Medical innovations
Beginning with their clinical investigation of methotrexate, clinicians and scientists in the Center for Arthritis and Joint Diseases have been in the forefront of efforts to evaluate novel therapies for rheumatoid arthritis. They have participated in trials of most of the anti-TNF products and are among the first group of U.S. centers to study a promising monoclonal antibody known as D2E7 (Adalimunab) for which FDA approval is expected imminently.
BWH physicians and patients also are involved in Phase II trials of a regimen combining two
biologic response modifiers—etanercept (Enbrel®) and a new agent known as CTLA4Ig which blocks a signaling pathway of the immune response. Preliminary data from this trial show that patients experience clinical response to the combination beyond that attributable to
Enbrel alone. BWH researchers expect to be involved in additional trials with CTLA4Ig soon.
They also are participating in an early study of the oral immunosuppressive drug
CCI, an ester of Rapamycin for patients with active rheumatoid arthritis. Michael E. Weinblatt, MD, Co-director of Clinical Rheumatology and Director of the Therapeutic Program in Rheumatoid Arthritis, observes that over the last 10 years, research has led to significant advances in the management of rheumatoid arthritis. “In our group, because we have been closely involved in the clinical studies, we are very familiar with the new agents and are more likely to use them sooner rather than later to benefit our patients.”
Rheumatoid Arthritis: Research
Research is also an important mission of the Center for Arthritis and Joint Diseases. Recently, researchers demonstrated that mast cells may play a significant role in the onset and development of rheumatoid arthritis. (See the journal Science, September 6, 2002). Beginning in early 2003, BWH physicians expect to begin enrolling patients in a rheumatoid arthritis registry. They hope eventually to enroll 1,000 patients and to study for five years their responses to therapy, their healthoutcomes, and the correlation of clinical response to genetic factors. Dr. Weinblatt says, “This prospective look at a large group of patients will complement our therapeutics research and will be an important resource in our understanding of rheumatoid arthritis.”
The Center for Arthritis and Joint Diseases provides comprehensive care through true integration of all specialties involved in the care of rheumatoid arthritis patients. Orthopedics, physiatry, radiology, physical and occupational therapy, podiatry, nutritional counseling, and laboratory services, as well as rheumatology are available in four convenient locations, accessible through 1-866-BWH-8288.
Brigham and Women’s Hospital
Center for Arthritis and Joint Diseases
45 Francis St., Boston, MA, 02115
Brigham and Women’s Orthopedic and Arthritis Center
850 Boylston St., Chestnut Hill, MA, 02467
Faulkner Hospital
1153 Centre St., Jamaica Plain, MA, 02130
Health South-Braintree Hospital
Orthopedic and Arthritis Center
250 Pond St., Braintree, MA, 02184
For more information, or to refer a patient for a consultation or a clinical trial,
call 1-866-BWH-8288.
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