Rheumatoid arthritis (RA) is a serious form of arthritis where the immune system attacks the body's own joints and other organs. Anyone can get RA – even children, but it commonly begins in the young- to middle-adult years. More women are diagnosed with RA than men, and they are usually affected during their childbearing years. According to the Arthritis Foundation, 2.1 million people have RA, and nearly 300,000 children between the ages of 18 months to teen years have juvenile rheumatoid arthritis (JRA).

The following is a transcribed speech that Arthur Kunath, MD, of Kunath, Burte & Temming, a single-specialty group in Crestview Hills, Ky., recently gave at an Arthritis Foundation Ohio River Valley Chapter meeting in Cincinnati.

Things are very different for the RA patient today compared to the turn of the century, because there has been a revolution in the understanding of the disease and the ability to treat the disease.

Just from a diagnostic point of view, we're able to assess damage and make a more accurate diagnosis early on because of the blood tests and X-rays we can obtain today. In 1900, they had just started using X-rays, but they didn't have the blood tests.

In 1900, a physician could only treat RA patients with pain medicine, morphine and/or aspirin. That was really about all they had. It wasn't until the 1920s that some of the more aggressive physicians began using gold salt compounds for the treatment of RA. Gold salt therapy was actually discovered serendipitously by doing a study on tuberculosis patients.

While the gold salts didn't help the tuberculosis patients, it did help the people with tuberculosis and RA. We picked that up in the mid-'20s. But even at that time, we only had aspirin and the occasional gold shots.

Around this time, the only way they could treat JRA was to put the child's arms and legs in casts until all their major joints fused together. They couldn't move, so their pain diminished. That was a pretty barbaric way of treating the patient, but some physicians didn't feel like they had a choice.

There weren't really any big discoveries until the '40s when Philip Showalter Hench at the Mayo Clinic discovered the cortico steroids. He entered this into the clinical practice in 1949, when his reports came out.

What's interesting is that after Hench published his study, he went to New York City and showed films of a patient of his that could barely walk up or down two stairs because of their advanced case of RA. He then showed a film of the same patient after he had treated them with the steroid. The patient walked up and down the stairs easily, without any pain.

So, for a short amount of time, we actually thought this was the cure for RA. But after a few years of treatment, we found out that it was a very potent, powerful drug with a number of side effects.

Over the '50s and '60s, we really spent that time learning how to use steroids appropriately. It was still a great medicine. In fact, we still use it today, but it was a revolutionary medicine that needed to be carefully applied in clinical practice.

The non-steroidal and non-Aspirin anti-inflammatories started in the 1960s. Then there was the introduction of Indocin, Motrin, Naprosyn and a whole host of other anti-inflammatories. That was helpful for the control of symptoms. Symptomatic control was about all we could offer the patients at that time.

Unfortunately, many of the patients at this point in time still continued to experience deterioration, and some of them had bad reactions to the gold salt therapy's toxicity.

In the '70s, the Cleveland Clinic began to use oral and injectable Methotrexate. This slowly gained popularity, so that by the middle '80s, it had been demonstrated in a number of important studies as more affective than gold, less toxic than gold, better tolerated than gold and it helped a significant number of patients.

At this point, we had a good 30 percent to 40 percent of patients with rheumatoid arthritis that responded well on just the Methotrexate. But even with all that, we had 60 percent to 70 percent of these patients on an anti-inflammatory, on steroids and on Methotrexate who still advanced and developed deformities.

Finally, at the end of the century, a series of compounds – known as the anti-tumor necrosis factor compounds – was discovered, and that had a revolutionary impact on rheumatoid arthritis. We could show significant symptomatic relief, halt progression of the disease and even prevent destruction, erosion and deformities in a significant number of patients. These drugs include Enbrel, Remicade and Humira.

In just the past few months, we've added two new medications: Orencia, which works on the T-cell interaction, and Rituxin, which helps RA patients quite significantly because it interferes with B-cells. So, we really have a number of drugs that are able to give us a better handle on RA.

The classic way of imaging these patients is plain radiographs of hands, wrists and feet. We look at those to see if there is any joint space narrowing or erosion. But over time, we discovered that this doesn't always distinguish enough. The X-ray response to this disease is often delayed, so we have started to think of ways we could get a head start and detect RA earlier.

We're now to a point where we think MRI may distinguish people who have early inflammation in the joints and erosive or destructive changes. These things can be seen earlier on MRI than plain films, at a stage where we can intervene and prevent progression.

For the small joints, we're starting to use ultrasound. Especially in the hands, this helps us to distinguish how much of an inflammatory burden the patient may have. So, those are the leading modalities that are being investigated. They aren't definitive yet, but I think there will be a place for both those modalities in the future when attempting to make an earlier and more accurate diagnosis.