Rheumatoid Arthritis

Traditional Treatments For Rheumatoid Arthritis

2007-08-27T17:27:00.000-04:00

Long standing and effective treatments for RA follow the severity of the disease, when it has been diagnosed and at what particular stage you may be relative to progression of this disease.

There are three classes of conventional treatment for rheumatoid arthritis that include fast acting drugs also known as "first-line" drugs, slower acting drugs also known as "second-line drugs and newer or "other" drugs and therapies.

First-Line Drugs

First-line drugs can include aspirin, naproxen, ibuprofen (Advil, Motrin, etc) and etodolac. These are all examples of a family of drugs called nonsteroidal anti-inflammatory drugs or, NSAIDS. NSAIDS are fast acting drugs that focus on pain, swelling and inflammation.

Your Rheumatologist may prescribe any of these drugs for you in early stages of RA or combine them with corticosteroid therapy such as cortisone injections or oral prednisone.

Second-Line Drugs

For more severe cases of RA and for rapid progression of the disease, your Rheumatologist may prescribe a second-line drug. Second-line drugs are known as 'disease-modifying anti-rheumatic drugs' or DMARDs. Some DMARDs are occasionally referred to as 'chemo' drugs because they can fall in the low-dose chemotherapy class of drugs.

Some traditional second-line drugs include Plaquenil, Azulfidine, Rheumatrex and Trexall (methotrexate), Imuran, Leukeran, and Sandimmune. These drugs also act as an immune system suppressant. A web search on any of these will give you plenty of additional information to make informed decisions.

DMARDs are slower acting, often taking weeks or months before providing any real benefit, and require careful administration by a Rheumatologist. Frequent blood work is necessary with these drugs to monitor and avoid some possible very serious side effects.

DMARDs are usually used in conjunction with first-line drugs to help with pain and inflammation.

Newer Drugs

Over the last several years a new class of RA drug therapy has been introduced called biologics. Biologics intercept a protein called the tumor necrocis factor (TNF) which is involved with the process of inflammation.

Biologics can act very quickly in reducing the symptoms of RA and many people have had excellent results using this new class of drug. Biologics are usually administered via self-injection once or twice a week.

Biologics include Enbrel, Remicade and Humira.

As with the DMARD treatments, biologics can produce some very serious side effects including a much lower immune system response, slower healing, heart and stroke issues and other serious issues.

As a side note: I was involved in an Enbrel clinical study about 4 years ago and noticed improvement after one injection. Within about 6 hours of receiving my first injection I noticed that I didn't feel like I had a low grade fever. For me, that in itself was such a relief! Unfortunately after about 4 months of treatment I had to stop due to complications with the drug.

Enbrel does work...I know this first hand. The problem with these new biologics is they are VERY expensive and many insurance companies will only cover part of the cost, if they cover the treatment at all.

Click Here for an in depth discussion of traditional treatment options by the Mayo Clinic.

Rheumatoid Arthritis and the Diet Connection

2007-08-25T08:35:00.000-04:00

I found out long ago how important your diet can be in managing the symptoms of RA. When I did have flare ups, I noticed they usually happened in the morning when my stomach was feeling queasy, as if I had eaten something the previous day that didn't agree with me.

I started to keep a record of what I was eating and what effect, if any, those foods had on my RA symptoms and general well being. The current literature at the time suggested RA sufferers generally stay away from the nightshade vegetables (tomatoes, potatoes, and peppers), fried and spicy foods and some dairy products.

That is still good advice.

However what wasn't mentioned was how our bodies are all different and what can effect one person may not effect another. This usually has to do with stomach acid levels and how difficult it might be for someone to digest their food properly.

The Food Culprits

Through a long process of elimination and trial and error, here is what I found to be what I call the hot food items that really hammer me. Should I consume any foods containing the following items, I usually have very severe (joint) pain, inflammation and swelling within 30 to 45 minutes.

1. Paprika
2. Dill
3. Basil
4. MSG
5. Processed sugar

As you can imagine, a large spectrum of foods contain these items.

Paprika is a killer for me. When I started reading food ingredient labels I was shocked to see how many food items contained paprika!

Why? As far as I can tell the stuff has no flavor and does absolutely nothing to food except add some red color.

If you have rheumatoid arthritis, the next time you eat a deviled egg covered with paprika, see how you might feel in an hour or so...

I discovered the effects of dill and basil quite by accident. I love to cook and I used a lot of basil in my cooking. When I stopped cooking with basil, my overall health improved.

And tell me, who doesn't like a warm, crisp dill pickle once in awhile.

MSG was a no brainer for me since it had always caused me to have heart palpitations. However, as I got older I noticed when I consumed foods containing MSG I also had increased joint pain and inflammation .

I always suspected processed sugar could cause digestion problems. Processed sugars actually change the level of acid in your stomach usually causing those levels to drop significantly such that it is difficult for your stomach to digest ANY foods properly.

Keep a Journal of What You Eat

Food allergies are nothing new but it is especially important for rheumatoid arthritics to take control of their diets and keep a record or journal of what they consume and how those foods may effect RA symptoms. You might be surprised to find how certain foods you eat regularly can dramatically increase your joint pain levels.

I am fully convinced that diet should be one of the most important areas of focus in RA studies and it certainly deserves much attention in assisting people who suffer from this disease.

Do your homework, educate yourself and learn how your diet may have a severe impact on your RA.

How I Control My RA

2007-08-21T09:48:00.000-04:00

I've been the conventional therapy route. I've been the natural therapy route. I've done the mind/body/spirit exercises. I've done just about everything trying to get a handle on this disease.

Early on I was placed on the nonsteroidal anti-inflammatory drugs (NSAIDS), the corticosteroids, and the sulfa drugs. All helped a bit, given my condition wasn't too bad at the time.

Later I was placed in a clinical study involving Enbrel (a newer medication called a 'Biologic') which did help a lot but I had to stop do to a reaction to the drug and possible serious consequences.

The Rheumatologists I have seen in the past all wanted me to try the 'chemo' drugs but after much research I found those drugs to be as dangerous, if not more so, then RA itself with no guarantees that they would help much.

Today, and for the past several years, I have settled on a combination of conventional and natural therapies.

A Combination of Conventional and Natural Therapies

I take 10 mg of prednisone each day along with 800 mgs of ibuprofen, up to 3 times in a 24 hour period based on how I feel. In addition (and this is my secret weapon) I have learned how my body reacts to certain foods. So I try to watch my diet closely.

Knowing that prednisone can cause bone loss, skin problems and other issues AND too much ibuprofen can cause kidney problems, I try to supplement with vitamins, calcium, garlic, hawthorn and an occasional liver and kidney cleanse.

The above routine keeps me alive, walking and functioning within a specific set of limitations, which I have come to accept in my life.

As a side note, and no offense to all the MDs out there, I have found that most general practitioners have no clue about RA, let alone a moderate treatment plan such as this.

Unfortunately I am one of the millions of Americans who has no health insurance, so going to a Rheumatologist is simply out of the question right now. Therefore I see a GP doctor at a walk-in clinic nearby and thank god he hasn't argued with me about taking prednisone each day for several years straight. It seems if you mention prednisone to most doctors they flinch and about fall out off their chair. "Prednisone is dangerous!", they caution.

Yeah, well, so is Methotrexate as it slowly destroys your liver and lungs.

I choose the lesser of the two evils.

Finally, I have to say this. Most Rheumatologists associate themselves with allergy clinics, charge big bucks for their so-called specialized knowledge and generally have no clue about other factors that can and will influence the severity of rheumatoid arthritis. If it isn't approved by the AMA, then it is considered snake oil.

I educated the very first Rheumy I saw in the effects that certain foods can have on RA patients. At first he blew me off, but then he told me he HAD seen a pattern in his patients with the foods that I mentioned to him. He became very excited.

The next thing I knew he couldn't wait to see me to compare notes on food items I had been studying and how they can effect RA. He eventually applied my findings in his practice and he did help many of his patients. All of that, and he still charged me up to $400 a visit! Such a nice guy.

YOU are In Charge of Your Body

My point is this: Take control of YOUR medical problems. Research, learn, ask questions. Find out what works for you and what doesn't. Find out what other factors may aggravate your RA. Visit your doctor with a detailed list of questions. After all, this is your body, not his!

And remember, when you leave that doctor's office, you become an after thought. Period.

YOU are in charge of your body...not a doctor.

Proceed accordingly.

What Rheumatoid Arthritis Is Not

2007-08-21T08:57:00.000-04:00

I would like to clarify some misconceptions and tell you what rheumatoid arthritis is not.

Rheumatoid Arthritis Is Not:

Just a pain in your thumb or an occasional pain in your knee.

Being told by your doctor "oh well, you are getting older and have a touch of arthritis. Take a couple aspirin."

About Osteoarthritis.

About age, getting old and lacking calcium.

Someone saying "oh ya, my grandmother had that...arthritis pain in her hip. I think I got RA too"

Some older guy or gal in a TV commercial who pops 2 Advil for "arthritis pain" and feels great for the rest of the day. (That commercial insults the hell out of me.)

In fact, rheumatoid arthritis is NOT solely about arthritis at all!

"Arthritis" is defined as "joint inflammation and swelling".

Rheumatoid arthritis is so much more then just "joint inflammation and swelling"

It should be called The Rheumatoid Syndrome because it encompasses much, much more then just joint pain and inflammation. Actually, RA is about a dozen different maladies all combined in one very painful, complicated and confusing package.

With just slightly over one tenth of one percent (1/10) of the American public being affected by RA, it's no wonder there are so many misconceptions about rheumatoid arthritis.

In any one day, there is actually more media exposure given to people who have a cold or a headache then there is to those of us who suffer this debilitating disease.

In addition to those symptoms I discuss in a post below, RA can and will have a severe impact on your skin, eyesight, blood vessels, heart, lungs and other organs.

Many times severe RA cases are fatal.

As I said, education is so important. Don't tell a RA patient that you can identify with him or her because you have a pain in your knee or your finger is swollen.

That ain't even CLOSE to what we feel and experience every hour of every day.

The Pain of Rheumatoid Arthritis

2007-08-21T05:29:00.000-04:00

What Is Rheumatoid Arthritis (RA)

According to the Arthritis Foundation rheumatoid arthritis is "a chronic disease, mainly characterized by inflammation of the lining, or synovium, of the joints. It can lead to long-term joint damage, resulting in chronic pain, loss of function and disability.

RA progresses in three stages. The first stage is the swelling of the synovial lining, causing pain, warmth, stiffness, redness and swelling around the joint. Second is the rapid division and growth of cells, or pannus, which causes the synovium to thicken. In the third stage, the inflamed cells release enzymes that may digest bone and cartilage, often causing the involved joint to lose its shape and alignment, more pain, and loss of movement."

Rheumatoid Arthritis:

affects about 2 million Americans a year.
generally affects more women then men.
can start in early childhood.
symptoms may manifest after severe trauma, a life changing event or even dental surgery.
symptoms may be associated with Lymes Disease

No one knows for sure what causes RA but there are several schools of thought. One says it is a bacteria, another says it is a virus, yet another says it's genetic.

Whatever the cause, the effect can be horrendous. The body's immune system kicks into hyperdrive, attacking itself and basically consuming itself as it attempts to fend off what it thinks are foreign invaders.

Symptoms Of Rheumatoid Arthritis

The following is a list of typical symptoms found in people predisposed to RA.

Fatigue and low energy levels
Joint pain, stiffness and inflammation
Weakness
Low grade fever and flu-like symptoms
Pain associated with prolonged sitting or standing
Muscle pain
Depression and other emotional issues
Painful lumps under the skin called rheumatoid nodules
Glandular changes around the eyes and mouth
Joint deformity
Loss of range of motion
General decline in overall health

Blood tests and a clinical evaluation by a Rheumatologist will determine if you do have RA.

Living With Rheumatoid Arthritis

I was diagnosed with this terrible disease about 12 years ago when I was in my early 40s. At the time, and after all of the tests, one doctor told me that I would be in a wheelchair within 5 yrs. Still another doctor, a few years later, told me I had 18 months to live.

Rheumatoid arthritis is considered a 'whole body' disease in that it affects you both physically and mentally.

In addition to the severe pain, inflammation and weakness, I continually run a low grade fever, can be irritable and depressed, have very little energy and have severe emotional ups and downs.

Those are the bad days, but not all days are like that.

The key to living with RA is to manage these symptoms and proceed with your life in a proper frame of mind.

Education Is Important

If you have been diagnosed with RA, you must get in the frame of mind of taking control of your own body and controlling where you will go with this. You must also educate yourself AND your family as to what to expect as you (and they) live with this disease.

People are a bit strange - especially healthy people. If someone can't SEE something physically wrong with you then they naturally assume everything is fine.

Communicate With Your Family

It's difficult for friends and family to see into your body and experience what is taking place. They can't experience the emotions, the sensations, the bone-on-bone grinding and twisting, the heat, the mental anguish, the confusion, the depression, the pain.

Educate yourself AND your family. Family members living with a rheumatoid arthritic can have their own set of issues.

They may wonder why you are irritable, or why you are having a difficult time doing simple tasks, or why you have no energy even after an entire night of sleep, or perhaps they may not understand those times when you simply can't go out in public and face even the simple things such as grocery shopping or going to the post office.

In order for your family and friends to understand you, support you and assist you, they must become educated and learn what people experience who suffer from RA.