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2012 Advances in Rheumatology

Dr. Christian Powell
Dr. Christian Powell practices rheumatology at 215 Pesetas Lane. Dr. Powell is certified by the American Board of Internal Medicine and has been with Sansum Clinic since 2011. He received his medical degree from University College Dublin School of Medicine and completed a fellowship in rheumatology at University of California Davis. Dr. Powell is a member of the American Medical Association and the American College of Rheumatology. You can contact our Rheumatology Department directly by calling (805) 681-7850.

by Christian Powell, MD, Rheumatologist

It is an exciting time to be a rheumatologist. With the development of self-injectable and oral medications, disease "remission" is an increasingly attainable goal. There have been numerous therapeutic advances over the last ten years in treating autoimmune inflammatory arthritis diseases such as rheumatoid arthritis, as well as, rarer vasculitic diseases such as granulomatosis with polyangiitis (formerly known as Wegeners granulomatosis). As our understanding of the intricate complexities of the immune system expands so does our ability to isolate new potential targets in the inflammatory cascade that fuels rheumatologic diseases.

We now have multiple biologic therapeutic options that work upon specific immune system targets. They are used to treat many rheumatic diseases such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and systemic lupus erythematosus (lupus). Biologics are infusible medications or self-injectable medications that act upon one of these specific targets and are given at varying intervals.

In the year to come, drugs with an entirely new mechanism of action are expected to be approved by the FDA: these are called Jak-Kinase inhibitors. These will be the first biologic medications for rheumatoid arthritis that can be taken orally. To date, all of the biologic medications are self injectable or infusion medications. In the preliminary studies, their efficacy is comparable to the current injectable biologics.

The treatment of Lupus has also seen recent advances in therapeutic options. Last year, the FDA approved a biologic called belimumab for treatment of lupus. It was the first new drug to treat lupus after 56 years, and is being tested for use in other autoimmune diseases. In the last several years, rituximab has been increasingly used in a subset of these disorders with excellent results. It is the first medicine in more then 30 years that has shown significant benefit to these often devastating diseases.

While biologics hold much promise including improved quality of life and overall improved disease control, they are always used with caution given potential serious side effects. All in all, we have clearly not reached disease eradication or cure for many of these inflammatory processes, but disease "remission" is an increasingly attainable goal.

In addition to medication advances, ultrasound is transforming rheumatology practice to aid in diagnosis and treatment. We are happy to announce that Sansum Clinic's Rheumatology Department has recently acquired a portable ultrasound machine. Ultrasound can be used as part of the physical exam to aid in detecting subtle inflammation within the joint. It can demonstrate bone erosions in such diseases as rheumatoid arthritis and this can be accomplished immediately with the patient during the office visit.

In rheumatoid arthritis, early detection of aggressive disease is vital so that appropriate medications can be started to prevent joint damage. Ultrasound may help to facilitate this early detection. We look forward to continuing to expand our skills and technique in this rapidly evolving and exciting new area of rheumatology.


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