Outlook Improves for Rheumatoid Arthritis Patients
August 18, 2006
By: Jean Johnson for Shoulder1
“It was more horrible than words can say when Jessie Franklin got rheumatoid arthritis,” said Sarah Boone of Phoenix who is in her mid-80s. “It was back in the late 1960s and our children were about raised. Our families had eaten a lot of chicken together over the years, and I loved Jessie. She was my best friend.
“Anyway, her knees had gotten so swollen she was hobbling around, and her elbows and hands were a mess too – her fingers all swollen and red and she couldn’t straighten her arms out. She was in so much pain that getting dinner on the table was a real chore. The doctors didn’t give her much hope, either.
| Try these lifestyle adjustments to help with rheumatoid arthritis:|
1. Balancing activity with rest:
Consider sleep as medicine for the body
Take a lead from the Latin world and try an afternoon siesta
2. Eating a healthy diet: Follow seasonal fare in your locale and eat fresh foods at their peak
Join the trend toward whole grains and leave white flour for the paste pot
3. Reducing stress: Listen to the birds – or a piece of music
Smell the mint, flowers or cookies your neighbor is baking
Follow the never-ending cycle of your breathing
Try Hatha yoga or tai chi
Visit a Japanese garden
4. Low-impact exercise: Swimming
“What she told me,” Boone said, “was that her doctor said rheumatoid arthritis was a condition that would get progressively worse and she’d probably wind up in a wheelchair or worse. Who knows what they said about her hands, I can’t remember. It’s probably because the news wasn’t very good there either.
“But fate intervened,” Boone said, letting her voice grow soft. “As it turned out, about a year later, she had a massive stroke that took her life. She was such kind, dear soul. I hope to see Jessie again one of these days when it’s my turn to go.”
What a difference 40 or 50 years makes. These days, the story on rheumatoid arthritis – at least in this case – is much less tragic. Indeed, with state-of-the-art medicines, three knee replacements, and some ultra-serious dedication to Pilates, 54 year-old Monica Blake of Pasadena, California is enjoying a pain-free, relatively normal life.
In June 2006 she told USA Today, that when she was first diagnosed almost 25 years ago when she was a young mother, “I literally had a leg that I dragged behind me.” Now, however, she walks without even a limp and after years as a Pilates student is has become a certified instructor teaching 4-5 classes a week.
Things go terribly wrong in autoimmune diseases like rheumatoid arthritis. The immune system, which is responsible for fighting disease, mistakenly attacks a person’s own body. Why this occurs is complex and not fully understood, but in the case of rheumatoid arthritis membranes in the joints thicken and swell damaging the cartilage.
Immune cells also attack cartilage directly as well as bone and surrounding muscles and tendons. The whole area becomes painfully inflamed and mobility and function of the joint is impaired. Worse, many joints are affected at once, particularly the feet, fingers, knees and elbows.
“Think of someone putting a nail through your knee or through your wrist,” said Blake.
Rheumatoid arthritis is different from other types of arthritis like osteoarthritis in that it tends to occur in a symmetrical pattern, affecting both knees or elbows for example. Also, although the disease often affects the wrists and fingers, it can affect other parts of the body. Finally, since rheumatoid arthritis is an autoimmune disease, it affects the entire body. People with this form of arthritis may feel tired and weak, have fevers at times, lose appetite and weight, and generally not feel well.
Safety Issues Surrounding New Medications
As in Monica Blake’s case, aggressive use of newer drugs are helping patients with rheumatoid arthritis enjoy lives less plagued by pain and disability than the one Jessie Franklin faced some 40 years ago. Nonetheless, advances in medicine don’t come without problems as a recent analysis published in the April 2006 issue of the Journal of Musculoskeletal Medicine by Kevin Deane, M.D. details.
“Rheumatoid arthritis affects large numbers of persons and is associated with significant morbidity and mortality,” Deane wrote as if to say: “this disease is a particularly bad one folks.”
“Although medicines used to treat patients with rheumatoid arthritis have increased therapeutic effectiveness, they may also have adverse effects and reactions. Patients must be counseled accordingly and then monitored closely for the development of adverse effects, especially infections which in some cases can be life-threatening,” he added.
One of the newer medicines, leflunomide doesn’t appear to be too problematic according to Deane, however. The drug was approved by the FDA in 1999, can cause GI problems in the first several weeks of therapy, although Deane notes that the symptoms tend to improve over time or with lower dosages. Diarrhea is the most common outcome and occurs in up to 17 percent of patients. Nausea, abdominal pain and vomiting are also seen to a lesser extent.
Rather, drugs that inhibit what physicians call the tumor necrosis factor A (TNF-alpha) and are termed anti-TNF-alpha agents are the ones that have given rise to greater concerns. “The incidence of active tuberculosis is increased in patients receiving anti-TNF-alpha therapy; careful screening should be performed before starting therapy,” wrote Deane. He added that, “Rates of lymphoma may be higher in patients treated with anti-TNF-alpha agents.”
Deane also discusses two new drugs, rituximab and abatacept, both of which he finds to be “well tolerated; serious adverse events do not appear to be increased significantly.” He adds, though, that “serious bacterial and viral infections may be the result of [a variety of] other immunosuppressive medications.”
Complementary and Alternative Medicine Approaches
Also on the cutting edge of treatment for rheumatoid arthritis are approaches from the world of complementary and alternative medicine (CAM). In its update on what the field has to offer to patients with rheumatoid arthritis, however, the National Institutes of Health National Center for Complementary and Alternative Medicine carefully underscores that “none of the CAM therapies discussed in this report have been proven to be of benefit for rheumatoid arthritis.”
The NIH adds that “Some – such as thunder god vine (which is not currently available in a safe American-made product), gamma-linoleic acid, fish oil and mind-body therapies – have shown some possibility of benefit for rheumatoid arthritis, but further studies are needed to answer this question for sure.”
Thunder god vine is a perennial native to China and preparations made from the skinned root have been used in traditional Chinese medicine to treat inflammatory and autoimmune disease. According to the NIH, “some anti-inflammatory and immune-system suppressing activity for thunder god vine has been seen in laboratory animals.” The NIH also says that an initial human trial of 21 patients undertaken at the University of Texas Southwestern Medical Center showed that 80 percent of those who took high doses and 40 percent of those who took low doses of an extract from thunder god vine “experienced improvement in rheumatoid arthritis symptoms and physical functioning. No one in the placebo group improved.” That said, the NIH points out that “longer and larger studies are needed to confirm these findings and to find out more about thunder god vine.”
On gamma-linolenic acid found in the oils of some plant seeds, the NIH is less certain as to efficacy surrounding purported abilities to reduce inflammation. Instead, fish oil seems to pass the government’s muster in somewhat better light, aside from the caution that mercury levels in fish contraindicate excessive consumption.
“There is some encouraging evidence from a number of laboratory studies, animal studies and clinical trials about the usefulness of fish oil or omega-3 supplementation for various aspects of rheumatoid arthritis – such as the number of tender joints, morning stiffness, and the need for NSAIDs (non-steriod anti-inflammatory drugs),” wrote the NIH. “However, more research is needed to definitively answer various questions, including what the most effective dosage or length of treatment would be, which patients would benefit most and whether a placebo effect is at work.”
Finally, as far as selected mind-body techniques like “meditation, tai chi, relaxation techniques, and spirituality for health purposes,” the NIH states that “Results from clinical trials indicate that the mind-body therapies may be effective additions to the treatment and management of arthritis including rheumatoid arthritis and its pain.” Toward this end, the NIH cites a 2003 study at Johns Hopkins University that demonstrated “people with moderate rheumatoid arthritis who had ‘spiritual transcendence’ had more happiness, joy and positive perceptions of their own health. This was regardless of how severe their rheumatoid arthritis was or how well they could function.”
Last updated: 18-Aug-06