“Winning the War Against Rheumatoid Arthritis”

[Guest guest]

RA is a condition that forces half of patients to become disabled from the work

force within five to ten years? and reduces life expectancy by as much as 18

years. RA affects about one per cent of the world’s adult population, most

commonly women between the ages of 30 and 50.

 

The good news is that a tremendous amount of progress has been made within the

last ten years in identifying patients earlier and treating the disease more

aggressively. Patients with RA, if treated appropriately, can lead a relatively

normal life. This is in stark contrast to the wheel-chair bound existence common

as recently as 20 years ago!

Experts in the field consider early rheumatoid arthritis to be a medical

emergency with mortality and morbidity equal to that for diabetes, asthma, heart

disease, and other life-threatening conditions.

Rheumatoid arthritis attacks the joints in a symmetric fashion (both sides of

the body affected equally) with the most common areas being the hands, wrists,

ankles, knees, and feet. In addition to the swelling and pain, patients with RA

often have profound fatigue and stiffness.

Rheumatoid arthritis is an autoimmune disease that attacks not only joints,

but internal organs such as the blood vessels, lungs, heart, and eyes. Patients

with RA are at increased risk for heart attack, stroke, and lymphoma.

Since many other types of arthritis such as gout, lupus, and osteoarthritis

can look like RA a careful diagnostic approach is needed.

Laboratory testing has its pitfalls. The rheumatoid factor, a blood test found

to be positive in about 80 per cent of individuals with RA, may also be positive

in other disease conditions. Couple that with the fact that 20 per cent of

patients with RA will be rheumatoid factor negative, then it becomes clear a

diagnosis should not hinge on the results of blood tests alone.

Imaging procedures can also be misleading. Conventional x-rays often miss the

erosions found with early disease. Newer imaging technologies such as magnetic

resonance imaging (MRI) and ultrasound are much more sensitive.

After the diagnosis is made, there is even more hope for a patient today. In

the past, non steroidal anti-inflammatory drugs (NSAIDS) used to be considered a

cornerstone of therapy. That is no longer true.

Disease-modifying anti-rheumatic drugs (DMARDS) are being used earlier. Among

the DMARDS currently being used are methotrexate, leflunomide (Arava),

azathioprine (Imuran), sulfasalazine (Azulfidine), cyclosporine, and

hydroxychloroquine (Plaquenil). These drugs attack the immune cells responsible

for chronic inflammation. While DMARDS alone in combination are effective, they

are relatively non-specific. Often, combinations of DMARDS are required.

Biologic Response Modifiers (BRMS) can target the disease more specifically

than DMARDS. RA is a disease that is dependent on the signaling that occurs

between immune cells. The signaling takes place through the use of special

chemical messengers called cytokines. BRMS act at both the cytokine (chemical

messenger) as well as the cellular level allowing the disease to be better

controlled and in some instances put into remission.

Biologic response modifiers, which include drugs that suppress tumor necrosis

factor (TNF), appear to be particularly effective.

Tumor necrosis factor is a protein that is produced by the immune cells. TNF

is the major culprit responsible for inflammation-inducing damage. By block the

effects of TNF, better control of RA can be achieved.

Three anti-TNF drugs are currently available: etanercept (Enbrel), adalimumab

(Humira), and infliximab (Remicade). Another biologic drug, anakinra (Kineret)

blocks interleukin, a different cytokine.

These drugs allow patients to have their disease controlled to such an extent

that most are able to enjoy a normal work and leisure existence.

On the horizon are other biologic drugs that work at different points in the

immune system- on different cytokines and on different pathways- to allow even

greater as well as more specific control of disease. Since rheumatoid arthritis

is a disease with many different cytokine and cellular mechanisms responsible

for damage, attacking the disease at different points makes sense. In the future

it may be possible to identify patients through specific tissue signals (called

“biomarkers”). These biomarkers will allow physicians to type patients and give

patients the specific therapy that will work best for them. Once that is

achieved, the possibility of a cure becomes a reality.

Everything, though, starts with early accurate diagnosis. If damage is allowed

to occur the chances for remission drop dramatically!

 

 

 

 

 

 

[Guest guest]

What about the people such as myself who have RA as a side effect of

chronic hep-c infection? I am unable to take the drugs that reduce the

immune response because of severely low blood counts. The RA drugs

normally prescribed could kill me. The only choice I've been offered is

opiates.

 

 

, kiran pari

<kiran_pari_786 wrote:

>

> RA is a condition that forces half of patients to become disabled

from the work force within five to ten years? and reduces life

expectancy by as much as 18 years. RA affects about one per cent of the

world's adult population, most commonly women between the ages of 30

and 50.

>