At NYUHJD's Seligman Center, Target Practice Makes Perfect

Seven years ago, 57-year-old Geri Cantello was convinced she would never walk again. During flare-ups of her rheumatoid arthritis - an autoimmune disease that attacks the joints and certain organs, such as the skin and lungs - she was wheelchair-bound and could barely dress herself or find the strength to pick up a bag of flour. "I had completely given up hope," she says. "I couldn't do anything myself. I was convinced it was the end of the road."

Then she came to the Seligman Center for Advanced Therapeutics at NYU Hospital for Joint Diseases. The center focuses on treating autoimmune diseases, including osteoarthritis, rheumatoid arthritis, psoriatic arthritis, osteoporosis, lupus, and Behcet's syndrome. In the spring of 2003, her physician enrolled her in a clinical trial for abatacept, a drug that was believed to help slow the progression of her disease. Eight months later, Cantello started walking again.

To some degree, doctors attribute her remarkable recovery to the drug that - for her, at least - was a magic bullet. But Cantello's comeback may have also been possible because of the kind of "target practice" that the Seligman Center is known for: a methodology that has been shown to help track and improve patient progress.

Two years ago, the center started asking all of its patients to complete the kind of detailed questionnaire that was given to Cantello as part of the clinical trial she was enrolled in. It contains 13 multipart questions that ask patients, for example, to rate their pain and fatigue on a scale from 0 to 10. The physician evaluates the different measures, adds up their total, and discusses the results with the patient. If the final score is above a certain threshold number, the doctor offers the option of more aggressive treatment.

"A cardiologist can tell how a patient is doing by measuring his or her blood pressure," says Yusuf Yazici, M.D., director of the Seligman Center. "Rheumatology has no such single measure. The questionnaires we've developed for clinical care help us quantify how patients are feeling and coping with their disease. They provide us with a target to treat toward, and lead us to be as aggressive as the disease requires us to be. As a result, our patients have the chance for better outcomes - less surgeries, longer life expectancies, and a better overall quality of life."

Other institutions use a similar methodology for select diseases or clinical trials, but the Seligman Center takes this approach one step further, applying it as a standard of care for all patients. That's difficult to do with conditions like rheumatoid arthritis because, unlike high blood pressure or diabetes, the disease doesn't have defined single measures that can be used for every patient.

The results of each questionnaire are entered into a database so that not only the physician can follow the progression of the disease, but the patient as well. "Patients who have a chronic illness often don't realize how their health is progressing from visit to visit," notes Ranit Shriky, the center's director of research and development. "They get used to their pain or don't really pay attention. "When the doctor shows a patient a graph of their progress at the end of a year, for example, it helps the patient realize how bad things really are - or how much they have improved. It opens up their eyes and, hopefully, empowers them to participate in their own care."

It opened up not only Cantello's eyes, but also her life. Every year, she says, she felt better than the one before. Cantello's doctor can still remember the joyous look on her face when she saw with her own eyes that her pain levels had dramatically decreased over time. "When you have a chronic disease," she says, "perception is everything. Those questionnaires made me realize that after years and years of getting worse, I was finally getting better. I owe them so much - and I owe the Seligman Center everything."

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For more information, call 212-844-0223 or visit med.nyu.edu/medicine/rheumatology.

Originally published in News & Views, November 2008