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March 5, 2003 A
University of Michigan Health Minute update on important health
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ANN ARBOR, MI - Nancy Brown can still remember her family talking about her great-grandmother - a woman who spent 10 years in bed suffering from what they called "rheumatism", which Brown suspects, after being diagnosed with the autoimmune disorder herself, was really rheumatoid arthritis.
Fortunately, the pain, which began in her knees and later spread to other joints, did not confine her to bed like it did her great-grandmother. However, when she was initially diagnosed almost 30 years ago, her only option for relief from her rheumatoid arthritis was to take 18 aspirin each day. Today, however, the nearly two million Americans affected with the disorder have several new medication options to bring relief to the joint pain and inflammation caused by rheumatoid arthritis. And rheumatologists with the University of Michigan Health System, have found that while these new drugs, called tumor necrosis factor (TNF) blockers, can be expensive, they are extremely effective in treating rheumatoid arthritis. However, as with all new medications, knowlege about side-effects are still evolving. Patients considering TNF blockers should consult with their primary care physicians. Arthritis refers to any disease involving joint inflammation or deterioration. While there are more than 100 types of arthritis, the two most common are osteoarthritis and rheumatoid. With rheumatoid arthritis, the joint lining becomes swollen and stiff causing white blood cells to move into the joint, which can potentially lead to damage of cartilage and bone. "Rheumatoid arthritis can be best explained as an inflammatory disease in which the immune system plays an unhelpful role," says David Fox, M.D., division chief of Rheumatology at UMHS. Symptoms of rheumatoid arthritis can begin at any age, even during childhood. However, the initial onset of the disorder in adults tends to start between the ages of 30 and 60. And like many other autoimmune diseases, women are twice as likely to develop rheumatoid arthritis then men. In addition to joint pain, swelling and stiffness, rheumatoid arthritis can also cause a loss of appetite, weight loss, a low-grade fever and a decrease in energy levels. Plus, Fox says patients with rheumatoid arthritis may also experience pain in their hands, feet and in other joints in the body at the same time. The onset of rheumatoid arthritis may also be unpredictable. Symptoms can occur suddenly, almost seemingly overnight, and cause pain and discomfort in 20 to 30 joints. Patients with this very severe, acute onset require extremely prompt treatment. With the other extreme, it may take patients, like Brown, anywhere from three months to one year or more to determine if their joint pain and swelling is the result of rheumatoid arthritis or another disease. "Since it began in my knees, we first thought I had tendinitis," Brown recalls. "There were a lot of diagnoses because it's difficult to pin it down that early." Regardless of how onset occurs, even if it's between those two extremes, rheumatoid arthritis is a serious disease that can significantly impact a person's life. Due to the number of joints that are affected, it can limit a person's ability to work and do every day activities. According to Fox, after 10 years with rheumatoid arthritis, at least half of the people who have the condition will not be able to work - a significant number of people, considering rheumatoid arthritis usually strikes during a person's prime working years. "I would say limitations have come with the progression of the disease," says Brown. "Those are the things that change your life." In Brown's cases, her hands and feet have been most affected by the disease. To increase her mobility she's had surgery, does special exercises, rests and wears shoes especially made for her feet. And Brown feels that catching the disease early on prevented it from progressing more rapidly. Fox advises anyone who is experiencing joint pain or swelling for more than week to make an appointment with their health care provider. "Generally, a primary care physician is first to see a patient with joint pain or swelling and if it seems to be something serious like rheumatoid arthritis, they may chose to refer the patient to a rheumatologist, who is a specialist in diseases of the joint," says Fox. Treatments for those patients who are diagnosed with rheumatoid arthritis include several medications including a non-steriodal anti-inflammatory like aspirin, or prednisone, a steriod-type medication. "Most effective in rheumatoid arthritis are the drugs that we call disease modifying antirheumatic drugs, such as methotrexate, or the more recently developed drugs that block the tumor necrosis factor (TNF)," says Fox. "TNF is an inflammatory molecule that's produced inside the joint in rheumatoid arthritis and with the new medications available, we're able to neutralize that molecule." Currently, there are three new TNF blocker drugs available in the United States to treat rheumatoid arthritis. While these new drugs are extremely effective, they are also the most expensive. Facts about rheumatoid arthritis:
For more information, visit the following Web sites: U-M Health Topics
A to Z: Rheumatoid Arthritis National Institute
of Arthritis and Musculoskeletal and Skin Diseases Arthritis Foundation American College
of Rheumatology
Written by Krista
Hopson
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