Comprehensive treatment approach helps patients manage rheumatoid arthritis

Although rheumatoid arthritis is an autoimmune disease with no cure, a tailored, multidisciplinary treatment approach at Cedars-Sinai's Inflammatory Arthritis Clinical Center helps patients get back to the activities they enjoy.

It may take trying different medications and a bit of time, but I tell patients that we will work together with a goal to get back to their work, their family life and all the things that they like to do, with no limitations."

Jon Giles, MD, MPH, rheumatologist, director of the Inflammatory Arthritis Clinical Center in the Division of Rheumatology and the Department of Medicine, Cedars-Sinai

Giles, an associate professor of Medicine, joined Cedars-Sinai from Columbia University in 2024 to establish the Inflammatory Arthritis Clinical Center, which also treats people with all other types of inflammatory arthritis, such as psoriatic arthritis and related spondyloarthropathies; and crystal arthritis, such as gout and calcium pyrophosphate deposition disease. Giles also leads research into the causes of autoimmune diseases.

Rheumatoid arthritis affects more than 3 million people in the U.S. and is more common in women than men. It causes inflammation, swelling and stiffness in the joints-prominently in the hands and feet but also in larger joints. Rheumatoid arthritis can also be associated with other potentially severe health conditions, including interstitial lung disease, accelerated cardiovascular disease, and an increased risk of certain malignancies and osteoporosis.

As co-director of the Rheumatoid Arthritis Translational Research Program in the Kao Autoimmunity Institute at Cedars-Sinai, Giles co-leads a comprehensive research program focusing on screening, diagnosis and management of these common but often overlooked-and sometimes deadly-complications.

In recognition of National Arthritis Awareness Month in May, the Cedars-Sinai Newsroom spoke with Giles about the latest treatment and research advances.

When does rheumatoid arthritis typically develop?

Some people think of rheumatoid arthritis as a disease that only older people get, but we treat adults of all ages. While women and men tend to develop the disease around 50, there also is a peak for women during childbearing years.

How are rheumatoid arthritis and osteoarthritis different?

Osteoarthritis can affect some of the same joints as rheumatoid arthritis, but it's caused by non-inflammatory damage to cartilage and underlying bone. It tends to bother people toward the end of the day or when they use their joints. With rheumatoid arthritis and most forms of inflammatory arthritis, joint stiffness is at its worst in the morning and tends to improve with activity. Also, unlike osteoarthritis, it is caused by a complex and not completely understood dysregulation of the immune system, leading to elevated inflammation and immune activation in the joints and throughout the body.

How effective are treatments for rheumatoid arthritis?

Today I can confidently tell patients there are many resources to treat this disease, and that very few patients do not respond to any of the available treatments. Twenty years ago, that was not the case. Sometimes, our trainees don't consider rheumatoid arthritis a severe disease because they see mostly people who have been diagnosed early and treated aggressively, who don't have advanced deformity and destruction in their joints and all the accompanying health conditions we once saw.

That said, if not treated effectively, rheumatoid arthritis can be quite severe. At Cedars-Sinai we "treat to target," meaning if a patient is not in low disease activity or remission-usually no or only a few swollen and/or tender joints-we adjust their therapy. We don't let active inflammation fester. Studies have shown this to be very effective at improving quality of life by reducing inflammation, symptoms and joint damage.

How often should patients with rheumatoid arthritis be evaluated by their doctor?

We recommend seeing a rheumatologist and getting screening blood work done every three to four months. We don't use a "set it and forget it" treatment approach. Sometimes patients stop responding to a medication, so both the patient and the physician must be willing to make changes. There may be complexities and subtleties in treatment-such as combination therapies with an injected medication and oral medications, each taken at different times-but with all the available medications today, patients generally do very well.

Why is multidisciplinary care important with this disease?

We take a multidisciplinary approach in treating rheumatoid arthritis-associated interstitial lung diseases, which can be very severe and lead to lung transplant, or sometimes even death. We collaborate with our Women's Guild Lung Institute to determine the best treatments for these patients because some of the medications to treat their lungs might not be the medication that we would use to treat their joints, and vice versa.

What research is underway?

At the Kao Autoimmunity Institute, along with our Lung Institute colleagues, lung transplant physicians and lung pathology specialists, we're focused on understanding how rheumatoid arthritis and interstitial lung diseases develop and how to treat them. As we've been treating rheumatoid arthritis more aggressively over the years, most of the very severe organ-threatening manifestations outside of the joints have declined-except for interstitial lung diseases. We also study the mechanisms behind accelerated atherosclerosis in people with rheumatoid arthritis, and how to best screen for and treat it. We are interested in the way inflammation affects muscle and fat tissue in the body and how this contributes to poor outcomes. In addition, we are starting clinical trials of new treatments that may be more effective than current therapies.

What do you most enjoy about your work?

It's rewarding to be able to say to someone starting treatment, "How you feel right now is not how you are going to feel in the future." Rheumatoid arthritis is a long-term disease that requires ongoing care, giving rheumatologists time to build strong relationships with their patients. I was fortunate to have many of those in my 13 years at Columbia University and now I'm doing the same at Cedars-Sinai.