Early Arthritis Initiative

The Early Arthritis Initiative (EAI) is committed to the education of the community, local physicians, and individual patients. It was established to:

• Promote the early identification and treatment of arthritis
• Support research efforts to determine more effective treatment and prevention strategies for arthritis
• Provide essential support and education for people with a new diagnosis of inflammatory arthritis

Recent research has shown that early diagnosis and treatment of rheumatoid arthritis can dramatically change the course of the disease. Patients who wait too long to be evaluated and treated may miss out on a narrow window of opportunity to prevent unnecessary destruction of their joints. It is integral to our mission to raise public awareness about the benefits of early detection, diagnosis, and treatment of rheumatoid arthritis, through outreach and community education.

Treatments may include medication for inflammation, medication to prevent joint damage, referrals for exercise and physical therapy, and/or advice about nutrition and supplements. Patients also have the opportunity to learn about what is going on in the world of rheumatology research that could potentially improve their care.
The EAI offers regularly scheduled community lectures and support and education programs for people with RA, which offer unique opportunities for learning about this illness, both from medical professionals and from peers with the same diagnosis. These programs were developed to provide a welcoming forum where people with RA can share concerns and also have access to:

• Reliable, easy-to-understand illness-related information from healthcare providers
• Coping strategies and emotional support from peers who understand

Faculty and Staff

The EAI is staffed by a team of experienced physicians and clinicians who have expertise in the diagnosis and treatment of rheumatologic diseases.

• Theodore R. Fields, MD, Clinical Director, HSS Early Arthritis Initiative
• Vivian Bykerk, MD, Director, HSS Inflammatory Arthritis Center; Research Director, HSS Early Arthritis Initiative
• Adena Batterman, MSW, LCSW, Manager, RA Support and Education Programs
• Joan Westreich, LCSW, Social Work Coordinator, Early RA Support and Education Program
• Linda Leff, RN, Nurse Manager, HSS Infusion Center

Frequently Asked Questions
What kind of symptoms should be evaluated by a doctor if you suspect arthritis?

• Joint pain for less than 3 to 6 months
• Joint swelling or stiffness, particularly in the morning, for less than 3 to 6 months

Strong data shows that it is especially valuable for certain kinds of arthritis, like rheumatoid arthritis, to be diagnosed and treated very early.

Why should I see the doctor for a few aches and pains?

The latest research has shown the critical importance of early treatment of arthritis, especially rheumatoid arthritis and other inflammatory types of joint pain. The earlier you identify the cause of your pain, the better you’ll be able to fight the disease or find out what’s going on. This is particularly true of rheumatoid arthritis, where early identification and treatment can actually stop the disease from progressing further. If you have morning stiffness or swelling of joints, this is an especially important signal that early evaluation is critical.

Why did HSS start the Early Arthritis Initiative?
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HSS has the largest rheumatology program in the United States. Many spend most of their time taking care of patients, and some spend almost all their time in research. The Early Arthritis Initiative reflects the collaboration between these two physician groups.
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• Can Tight Control of Early RA - With a Target - Help You Feel a Lot Better and Reduce Joint Damage?
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• Surgery: When Splinting Isn't Enough for RA

• For Professionals​

For Professionals

​In 2008, the Hospital established the Inflammatory Arthritis Center based on "best evidence medicine" with the following intersecting tenets:

Providing comprehensive care to patients with RA and spondyloarthropathies

• Educating medical students from the Weill Cornell Medical College, residents from NewYork-Presbyterian Hospital, and fellows and attendings from HSS
• Facilitating translational research by enhancing communication between basic science researchers and clinicians and formulate the foundations for clinical research at HSS
• Promoting basic and clinical collaborations with the pharmaceutical industry and participate in the development of novel therapeutics for patients with inflammatory arthritis

​As part of its commitment to providing optimal care to patients, the IAC conducts a weekly clinic, followed by a conference involving rheumatology attendings, a radiology attending, medical students, residents, fellows, and social workers in an interdisciplinary discussion of patients with diverse clinical problems so as to highlight evidence-based therapeutic decisions and assessment of outcomes. The IAC has developed and implemented a comprehensive computerized registry and a database of patients with rheumatoid arthritis. Registries in other inflammatory conditions, including ankylosing spondylitis and psoriatic arthritis, are being developed.

Three clinical trials that were incorporated into the IAC are nearing completion, and two new studies are soon to be launched. Proposals for several investigator initiated trials have been submitted on several topics including the use of a new anti-biological agent, certolizumab. In addition, several national and international database collaborations are being explored. An effort to promote a closer interaction between clinical and basic science research at HSS has been initiated. This translational approach has encompassed several activities, including a project on the
characterization of cytokines and dendritic cells in patients with psoriatic arthritis. Two new fellowship research studies have been proposed that require the facilities of the IAC.
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As the IAC continues to develop, the primary objectives will be to continue to build the respective registries so as to begin generating hypotheses, research studies, and publications that cross the basic science and clinical platforms.

Inflammatory Arthritis Center

The physicians and healthcare professionals at the Inflammatory Arthritis Center are committed to improving the lives of people with inflammatory arthritis through individualized, high-quality patient care; education services for patients, family, caregivers and policy makers; and clinical research initiatives designed to gain a better understanding of the causes of inflammatory arthritis and to bring new innovations to patient care. As an internationally recognized Center of Excellence, the IAC is also training the next generation of medical providers.

• Meet the Team
• Patient Care and Education
• Early Arthritis Initiative

Patient Care and Education
Inflammatory Arthritis is a serious and systemic disease that includes many subtypes. These diseases predominantly affect the joints, but can also involve other parts of the body including the heart, lungs, eyes and skin. Rheumatoid arthritis is the most common form of inflammatory arthritis, affecting an estimated 2 million people in the United States. However, there are many different kinds of inflammatory arthritis that affect millions more individuals every year.

Most forms of inflammatory arthritis are progressive and, if left untreated, will result in pain, disability, and serious damage to the joints. However, rheumatologists (the physicians who specialize in the care of people with inflammatory arthritis) have more treatments available than ever before to help those diagnosed cope with symptoms and maintain their quality of life. It’s important for those who have been diagnosed to know that a growing body of research shows that treatment is most effective when it begins early in the course of the disease.
The rheumatologists and other staff at the Inflammatory Arthritis Center at Hospital for Special Surgery use a combination of nonsurgical techniques, including medications to relieve swelling and pain, while regulating the immune symptom. For many people with inflammatory arthritis, these treatments successfully control symptoms, and slow or even halt the progress of their disease. Surgical options may be appropriate in certain situations where severe joint damage has occurred.

Resource Guide
Coping with inflammatory arthritis can be challenging. That is why it is important to learn as much as possible about your condition. We hope you will find the resources in this guide to be helpful.

Inflammatory Arthritis Clinic
The Inflammatory Arthritis Clinic assesses and treats patients affected with inflammatory arthritis. The IAC includes health providers dedicated to the care and improved understanding of these disorders. Over 60 patients are treated at this weekly clinic, where they benefit from the highest quality care provided by a multidisciplinary team that includes expert attending physicians who oversee fellows, residents and students, as well as social workers, a radiologist, scientists, nutrition services, occupational therapy and physical therapy. Patients seen in the clinic can be participants in inflammatory arthritis registries and help with scientific studies and physician education.

Experts at the Inflammatory Arthritis Center have authored many articles on Inflammatory Arthritis. See below to learn more about specific types of this disease as well as treatment options.
Major types of inflammatory arthritis include the following:
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• Rheumatoid Arthritis
• Psoriatic Arthritis
• Ankylosing Spondylitis
• Reactive Arthritis
• Gout and Pseudogout

Fast Facts about Inflammatory Arthritis
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• Inflammatory arthritis refers to a group of disorders caused by an overactive immune system that results in inflammation.
• Inflammatory arthritis is also described as an autoimmune disease, which means that the body’s immune system sees its own healthy cells and tissues as “foreign”, and sets up to attack them.
• Most types of inflammatory arthritis primarily affect the joints, tendons and ligaments. However it can also affect the heart, lungs, skin, eyes and other organs.
• People with inflammatory arthritis can develop the disease at any age, even as toddlers.
• Symptoms of inflammatory arthritis depend on the type of the disease. Some forms, such as rheumatoid arthritis and psoriatic arthritis affect the smaller joints, while others, such as spondylitis, affect the spine.
• Inflammatory arthritis is different from osteoarthritis, a disease that is seen more with aging. (Osteoarthritis also affects the joints; however, this is not the result of the body’s altered immune response.)
• If left untreated, inflammatory arthritis can result in irreversible damage to the joints and other affected organs.
• Treatment can be most effective when it begins early on in the course of the disease.
• Rheumatologists are expert physicians specialized in diagnosing and treating inflammatory arthritis and autoimmune diseases where joints can be involved.
• With treatment, inflammatory arthritis can often be well-controlled and put into sustained remission, a state in which symptoms subside, and the risk of damage is greatly reduced.

​Support and Education ProgramsHSS offers a number of free programs that reflect our comprehensive approach to care for people with rheumatoid arthritis.

Living with Inflammatory Arthritis: What You Need to Know
HSS Health Connection by Community Education & Outreach
From the issue, Living With Inflammatory Arthritis

By Vivian P. Bykerk, BSc, MD, FRCPC

Inflammatory arthritis is a condition many people endure for a lifetime. Thanks to advances in treatment, however, innovative medications can delay and even halt the progression of the disease, and non-drug approaches have can help relieve symptoms so you can live a full and productive life.

• What is inflammatory arthritis?
• Inflammatory arthritis vs. osteoarthritis
• Types of inflammatory arthritis
• You and your rheumatologist: A lifetime partnership

What is inflammatory arthritis?Inflammatory arthritis describes a group of diseases caused by an overactive immune system. The most common symptoms are joint pain and stiffness. Affected joints may feel warm, swollen, and tender. But inflammatory arthritis can also affect other tissues in the body, including the lungs, heart, eyes, skin, and other organs. Left untreated, it can cause irreversible damage. Early treatment is the best way to relieve symptoms and limit the effects of inflammatory arthritis on the body.

While it’s not known what causes inflammatory arthritis in every patient, what is known is that the immune system does not know when to put on the brakes. Normally when we are exposed to bacteria, viruses, or fungi, the immune system produces white blood cells called lymphocytes as well as immune proteins to mount an attack against these invaders. Lymphocytes and immune proteins cause inflammation, which under typical circumstances is limited and resolves once the foreign substance is defeated.

But in someone with inflammatory arthritis, the immune response does not know when to stop. It turns on your body, attacking your own tissues instead of the foreign substance and causes continued inflammation. For this reason, inflammatory arthritis is known as an "autoimmune disease" − auto meaning "self" and “immune” because the immune system loses its ability to distinguish self from foreign.

Inflammatory arthritis vs. osteoarthritis

Although they share some common symptoms, inflammatory arthritis and osteoarthritis are very different diseases. Osteoarthritis is a common condition causing wear-and-tear of the cartilage of the joints due to age and/or prior injury. Here are some other differences:

To view additional content, swipe left
Body parts, tests and causesInflammatory arthritisOsteoarthritis

Parts of body affected
A "systemic" disease which may affect the joints as well as other organs, such as the lungs, heart, eyes, tendons, and skinSymptoms are limited to the joints

Positive biomarker tests
Patients may show elevations in proteins such as rheumatoid factor, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) on blood testsBlood tests for biomarkers are negative

Causes
Autoimmune disease related to body-wide inflammation
Mechanical wear-and-tear on joints due to age or injury
Types of inflammatory arthritis

If you are experiencing symptoms that suggest inflammatory arthritis, your doctor will perform a number of tests, including a physical exam, blood tests, and imaging exams (such as X-rays, joint ultrasound, and/or MRI or CT scans). Sometimes the physician takes a sample of fluid from an affected joint for analysis − a procedure called joint aspiration. 

Based on the results of these exams, your physician will determine if you have inflammatory arthritis and if so, which type:

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis. It tends to involve more than one of the small joints of the hands and feet. In particular, the lining of the joint or tendons (the synovium) is inflamed, causing warmth, pain, and stiffness. In 30% to 60% of people with RA, blood tests confirm the presence of proteins called rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) antibodies. It is very important to control inflammation in the synovium to stop joint destruction and to treat RA to minimize damage to the heart, lungs, and eyes.

Psoriatic arthritis is a type of arthritis called a "spondyloarthropathy" that is a combination of psoriasis (red, scaly patches on the skin, especially the knees, elbows, and scalp) as well as pain and swelling in the large and small joints and sometimes the spine. It can cause complete swelling of a finger or toe − a condition called "dactylitis."

Juvenile idiopathic arthritis (JIA) affects young people under age 16, causing inflammation in the joints and sometimes in the spine and ligaments (tissues that connect bone to bone) that lasts for more than six weeks. Swelling or mobility problems, including a limp if the legs are affected, may be the only signs of JIA. Some types of JIA cause eye inflammation that can occur without symptoms, so prompt diagnosis, treatment, and monitoring of JIA are vital to prevent permanent damage. Children and teens with JIA are best treated by a pediatric rheumatologist.

Ankylosing spondylitis (AS) affects primarily the spin and hip joints, breastbone, and large joints in the body. Over time, AS can result in noticeably reduced motion in the spine. Up to half of people with AS have a gene called HLA-B27, the presence of which can help confirm the diagnosis of this condition when it is found in combination with AS symptoms.

Gout and Pseudogout (calcium pyrophosphate dehydrate deposition disease or CPDD) are forms of arthritis caused by elevated levels of certain crystals in the body. Gout results from excess uric acid, causing it to crystallize in joints such as the big toe and also raising the risk of kidney stones. CPPD occurs when calcium salts form in the joints and are engulfed by white blood cells, provoking inflammation − most commonly in the wrists and knees.
Other autoimmune diseases can cause inflammatory arthritis as a symptom. Examples include Sjogrens syndrome and lupus.

You and your rheumatologist: A lifetime partnershipIf you have inflammatory arthritis, it is imperative that you see a rheumatologist on a regular basis to monitor your health and customize your treatment. Rheumatologists are medical doctors with special training in the care of people with joint diseases and autoimmune diseases. They are different from orthopedists, who are trained in surgery and who may also be involved in the care of people with inflammatory arthritis when medical treatments are not enough.

How do you know whether to start with a rheumatologist or orthopedist? If you have ongoing joint discomfort without chronic swelling or other symptoms, such as fatigue, you may be able to see an orthopedist first. But if your joint pain is accompanied by warmth, swelling, other signs of inflammation, fatigue or discomfort in other parts of your body, a visit to a rheumatologist may be in order. Your primary care physician can guide you.

Because inflammatory arthritis is an autoimmune disease that can affect multiple parts of your body, you may need to see other specialists, too, to keep your symptoms in check and maintain the best quality of life possible.

To prepare for your visit with a rheumatologist:

• Bring in a full list of your medications, including vitamins and supplements.
• If you are already taking medications for inflammatory arthritis, make any notes about reactions or side effects you may be experiencing.
• Bring copies of blood and imaging test reports, which can help your physician better understand your arthritis.
• Provide a list of all health conditions you have had, prior surgeries, and symptoms you may be experiencing.
• Prepare a list of questions you may have for your doctor.

Your rheumatologist may choose from a variety of treatment options for inflammatory arthritis, depending on the type and severity of your disease, such as:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen.
• Steroid medications (corticosteroids) such as prednisone, which are typically used for shorter periods of time because of their side effects.
• Traditional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, hydroxychloroquine, sulfasalazine, minocycline, and leflunomide.
• Biologic DMARDs, which target the proteins driving inflammation, such as infliximab, etanercept, abatacept, adalimumab and rituximab. These medications have revolutionized the care of people with inflammatory arthritis, sparing many from surgery.
• Surgery may be indicated for specific joints with damage that can no longer be controlled by medications.

A diagnosis of inflammatory arthritis can initially feel overwhelming. It can take weeks or even months to come to terms with and understand what having this disease can mean in your life. By developing a close working relationship with your rheumatologist and other caregivers, however, there is much you can do to control inflammatory arthritis and maintain an independent and active lifestyle.

If you or someone you know is living with a chronic inflammatory condition, learn about the different patient support programs available at HSS.
Updated: 2/9/2022

Authors
Vivian P. Bykerk, BSc, MD, FRCPC
Director, Inflammatory Arthritis Center of Excellence

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• Inflammatory Arthritis in Children: More than Growing Pains

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Related Content

• Ankylosing Spondylitis
• Gout
• Inflammatory Arthritis
• Juvenile Arthritis
• Juvenile Idiopathic Arthritis
• Pseudogout
• Psoriatic Arthritis
• Reactive Arthritis

​Departments and Services

• Inflammatory Arthritis Center
• Rheumatology
• HSS Health Connection
• Community Education & Outreach

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