28th November 2014


Collaborative treatment in the biologic age

Collaborative treatment in the biologic age

"Biologics" are bringing greater precision to patient care.
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Nancy was 51 when she began noticing knee, ankle and foot pain after her routine two- to three-mile walks each morning.  She was told that she had osteoarthritis and treated with acetaminophen and ibuprofen. She thought she had solved the problem, until she began to experience severe stiffness in the mornings. Within two months, her hands and wrists were severely swollen, making buttoning her clothes, working on her computer, even holding a fork nearly impossible.

“Biologics” are medications, manufactured with new recombinant DNA technology, that are produced in living organisms instead of traditional chemical manufacturing.

Autoimmune diseases at all ages

After consulting with a rheumatologist, Nancy was diagnosed with rheumatoid arthritis, which is one of many conditions that is caused by disorders of the immune system, or autoimmune/ inflammatory disorders. These chronic conditions can plague patients with symptoms such as joint pain, rash, cough and fatigue, and symptoms involving many other organs. Autoimmune disorders affect more than 500 million people in developed countries, and the total prevalence is growing. For many of these diseases, complications can arise in multiple organ systems, requiring multiple doctors and immediate care.

Sean is a 46 year old man who suffered from psoriasis since the age of 24. While his skin disease was under control, he began noticing abnormal swelling in his toe, and later in his finger and knee. Sean jogged regularly to help prevent heart disease, which had claimed the lives of several men in his family, but soon he was unable to continue because of swelling and pain in his Achilles tendon.  Sean consulted with a rheumatologist and was diagnosed with psoriatic arthritis.

Another patient, a young and active 28-year-old woman, experienced a facial rash, intermittent fevers, joint pain and mouth ulcers. After she was hospitalized with pericarditis she was quickly diagnosed with systemic lupus erythematosus (SLE, also known as lupus) and treatment was initiated.

Biologics are engineered to target specific proteins in your body that cause inflammation and can lead to illness.

Common ground

Each of these patients’ stories are unique, but they have two important features in common: Their diseases are being treated with cutting edge “biologics” medications and their ongoing care requires close partnership of physicians from a myriad of specialties to provide optimum long-term management.

“Biologics” are medications, manufactured with new recombinant DNA technology, that are produced in living organisms instead of traditional chemical manufacturing. Biologics are engineered to target specific proteins in your body that cause inflammation and can lead to illness. They can be more specific than some traditional therapeutic approaches.

Transforming lives

“The biologic therapies that have transformed patient lives, controlled their diseases and prevented disability wouldn’t have been available or even imagined 20 years ago,” said Abby Abelson, M.D., Chair of the Department of Rheumatic & Immunologic Diseases, Orthoapaedic and Rheumatological Institute, Cleveland Clinic.

Basic science research has resulted in the identification of biological pathways that are responsible for the pain and disability that can result from diseases such as inflammatory arthritis, systemic lupus erythematosus (SLE) and osteoporosis.

“Cutting edge translational research and biotechnology has enabled the targeting of these pathways with treatments that prevent disease progression,” said Dr. Abelson. “Patients across the globe are now able to reap the benefits and be able to take targeted medications orally, through injections and intravenous infusions to control their diseases. Continued support for the research that generated these treatments and support for improving access to care is paramount to ensuring the patients well-being.”

"Patients across the globe are now able to reap the benefits and be able to take targeted medications orally, through injections and intravenous infusions to control their diseases."

Collaborative care

Furthermore, appropriate care for these patients requires physician collaboration along with healthcare professionals from across specialties to partner in a system of care.  At Cleveland Clinic, physicians and healthcare professionals provide interdisciplinary care in multispecialty clinics focused on rheumatic diseases, including osteoporosis and metabolic bone diseases, arthritis and musculoskeletal diseases and vasculitis and clinical immunology.

“Being part of Cleveland Clinic means our team provides patient-centered care on a daily basis. Patients travel to us because they have access to multiple specialists who collaborate in providing care of their multi-system diseases.”

After biologic treatment, Nancy is back at her job in executive management and enjoying walking again. Sean is now pain-free and back to jogging while self-injecting the biologic therapy that controls his rheumatoid arthritis and psoriatic arthritis, and the patient with Lupus has finally regained her quality of life.

Abby Abelson, M.D.

Chair, Department of Rheumatic & Immunologic Diseases Orthopaedic and Rheumatology Institute
Cleveland Clinic

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