Section I: Devastating Effects

Voice Over: Welcome to Beneath the Skin, an in-depth look at rheumatoid arthritis, otherwise known as RA. RA is a systemic, inflammatory disease that causes deformity in the joints and affects more than two million people in the U.S. The causes of RA are unknown.

QUICK FACT: About 1% of the population of the United States, or 2.1 million people, have RA.

RA is one of the most debilitating types of arthritis. Left untreated, it can cause severe joint damage. Even with use of the most common RA medication, methotrexate, joint damage can occur over time.

Here you will see the progression of damage in an RA patient treated with methotrexate alone over a ten-year period.

Watch as we see how RA affects the joints in the hand at the skin, bone, and joint levels.

The signs and symptoms of RA typically begin slowly, and develop over months. However, as you can see here, RA begins to affect the joints soon after the onset of the disease. The cartilage between bones begins to deteriorate within the first couple years, leaving the spaces between joints to narrow and cause pain. Patients with active RA disease have a greater than 70% chance to develop joint damage within two years of the condition’s onset.

One of the defining factors distinguishes of RA is that joints on both sides of the body are affected.³ The patient whose hand you see here would most likely have symptoms and joint damage in the other hand as well.

The animation shows how the hand becomes increasingly misaligned with time, making the deformity quite visible.

Notice how the progression of RA has left the hand permanently deformed after ten years, severely limiting the range of motion.

Joints on both sides of the body are usually affected equally by RA.

The joints most often affected by RA are in the:

• Hands
• Feet
• Wrists
• Ankles

• Joint stiffness, pain, and swelling
• Difficulty moving the affected joints
  

50% of RA patients experience work disability within a decade of diagnosis. Interested in seeing what’s happening beneath the skin? Let’s take a look.

Section II: Damage Over Time

Voice Over: This 3-D animation illustrates what is happening beneath the skin to cause the symptoms of RA.

The skeletal model shows how joint damage progresses over ten years in an RA patient treated with methotrexate.

Joint damage has two main causes: joint space narrowing, when the gap between bones closes; and joint erosion, when the inflammation in joints causes bones to erode. When cartilage that helps support the joint wears away, the spaces between joints narrow.

Notice how, in the early stages of RA, the spaces between the joints are noticeably smaller. The cycle of pain, stiffness, and limited mobility now begins.

Joint space narrowing and joint erosion occur independently of each other and can both steadily progress over time.

As you can see, joint damage can continue, even when pain and swelling are relieved. Methotrexate alone may not always inhibit the progression of crippling joint damage.

Notice how the bones shift out of alignment and away from the wrist, making the deformity clearly visible. They cannot be straightened. Even simple tasks that involve grip strength, such as writing or washing dishes, can become difficult.

But this isn't the whole story. Ready to go even deeper? Let’s zoom in on a close-up view of joint damage.

The image at right shows the progression of structural damage in a patient treated with methotrexate alone over a ten-year period.

Section III: The Joint Close-Up

Voice Over: Now we’re deep inside the picture of RA – right where it all begins, at the joint. What you see here is a close-up view of shows an individual joint in an RA patient treated with methotrexate over a ten-year period. One clinical study found that joint erosions began to occur within the first year after onset of the disease.

• Rheumatoid arthritis often causes the spaces between joints to narrow over time. This can cause deformities and tendon destruction. Joint erosion, or the destruction of bone at the joint, is one of the two major components of the overall joint damage in rheumatoid arthritis. As part of the inflammatory process, proteins are released that can cause a breakdown of the bone at the joint.

Throughout the years, the bones become more noticeably damaged or eroded.

Studies show that in RA patients, between one and three joints per year become eroded, and between one and two joints per year narrow.

• Fortunately, there are now therapies available that address not only the signs and symptoms of RA, but also target the underlying joint damage.

Section IV: There is Help

Voice Over: REMICADE^® (infliximab), in combination with methotrexate, is indicated for reducing the signs and symptoms, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis. REMICADE is not for everyone. Click to read important safety information. Talk to your rheumatologist to see if REMICADE is right for you.

More Information About REMICADE

Visit featured areas of REMICADE.com using the links below.

• Learn more now about REMICADE as a treatment for rheumatoid arthritis. Click here to learn more now.
  
• Find a medical specialist who treats patients with rheumatoid arthritis in your area. Find a specialist now.