A link between stress and rheumatoid arthritis (RA) is commonly acknowledged. However, scientists continue to explore the connection between the nervous and immune systems and the effect on RA onset and progression. People with RA commonly report experiencing physical or emotional stress when first diagnosed with an autoimmune disorder like RA. However in a 2010 editorial in Arthritis Research & Therapy, Daniel Clauw, MD, a professor of anesthesiology at the University of Michigan (who has expertise in rheumatology and pain), commented on a review of 16 studies on the stress-arthritis link. In his editorial, Dr. Clauw highlighted the verified link in animal models and the difficulty in proving a similar linear relationship in humans.
For decades, X-ray images have been used to help detect rheumatoid arthritis (RA) and to monitor for the progression of bone damage. In early RA, however, X-rays may appear normal although the disease is active – making the films useful as a baseline but not much help in getting a timely diagnosis and treatment.
Enter modern imaging techniques, including ultrasound and magnetic resonance imaging (MRI), which can reveal early, non-bony signs of RA that are invisible on X-ray.
“Both MRI and ultrasound are more sensitive at detecting bone erosion than X-ray. In addition, they also reveal inflammation, which we could not see directly before and had to rely on blood tests and using our fingers to feel the joints,” says rheumatologist Philip Conaghan, MD, PhD, professor of musculoskeletal medicine at the University of Leeds and president of the International Society for Musculoskeletal Imaging in Rheumatology.
An emerging class of medications called janus kinase inhibitors (JAK inhibitors, or jakinibs) is offering new hope to patients with rheumatoid arthritis (RA) who don’t find relief with other treatments.
What are Jakinibs?
Jakinibs are a new class of medication, sometimes called oral biologics. The word “biologic” is misleading, however, because jakinibs work in an entirely different way than the biologics that have been used to date. Jakinibs are small molecules that work inside cells. Traditional biologics such as etanercept (Enbrel), adalimumab (Humira), abatacept (Orencia) and Infliximab (Remicade) block pro-inflammatory cytokines from outside.
Jakinibs are taken by mouth. Traditional biologics are given through infusions or injections.
As you know, rheumatoid arthritis is a disease of the joints, but a subset of people with RA say
that it can also take a toll on a very important organ: the brain. They describe feeling forgetful, unable to concentrate and gripped by the “blahs.” In other words, they say that rheumatoid arthritis gives them an unshakable case of brain fog.
Brain fog isn’t a medical term, but doctors have long recognized that patients with certain physical conditions (such as lupus and multiple sclerosis) can experience cognitive dysfunction, or the diminished ability to think, learn, remember and perform other mental tasks. Not all doctors who treat rheumatoid arthritis are convinced that brain fog represents an important concern for their patients. Yet recent research offers clues that diseases featuring chronically elevated inflammation, such as RA, may hinder healthy brain performance.
“I see it all the time,” says Marian Rissenberg, PhD, a neuropsychologist who works with patients coping with cognitive problems at Northern Westchester Hospital in Mount Kisco, New York. “These people are not malingerers.”