?Winning the War Against Rheumatoid Arthritis?

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!

Dr. Wei (pronounced "way") is a board-certified rheumatologist and Clinical Director of the nationally respected Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine and has served as a consultant to the Arthritis Branch of the National Institutes of Health. He is a Fellow of the American College of Rheumatology and the American College of Physicians. For more information on arthritis and related conditions, go to: http://www.arthritis-treatment-and-relief.com

In The News:

---

Top Ten Reasons Why We Hate IBS!

Irritable bowel syndrome can be a nightmare?constant diarrhea and terrible... Read More

Risperdal Side Effects: Neuroleptic Malignant Syndrome NMS

Risperdal is an atypical anti-psychotic drug that balances the levels... Read More

?Foot Pain Relief At Last!?

"As an arthritis specialist, one area that I see people... Read More

The Medical Community Changes Its Mind

How many of us have taken aspirin or a similar... Read More

Taking The Sting Out Of Bug Bites

(NC)-In most cases insect bites are harmless and if left... Read More

5 Risks to Avoid When Purchasing Discount Medicines Online

With the increasing price of prescription medications, many consumers are... Read More

Thimerosal: Autism and Mercury Poisoning Side Effects?

Thimerosal is a preservative that is added to vaccines (has... Read More

Phentermine Diet Pills: When Diet and Exercise Arent Enough To Help You Lose Weight

Have you been struggling to lose weight, but diet and... Read More

The Importance Of Using Electric Wheelchairs To Improve Mobility

No person likes to feel housebound and dependent on others.... Read More

Watch Out for Misleading Pharmaceutical Advertising

In 1997, the Food and Drug Administration relaxed the rules... Read More

Molluscum Contagiosum Virus (MCV) Treatment Information - But First, What Is Molluscum?

Molluscum contagiosum treatment is certainly possible with the correct treatment... Read More

Viga Lies Cause Potential Fatalities

Viga and Viga for Women is a dietary supplement sold... Read More

Web Therapy: Enhancing Patient Communication with Web Access

According to Jennifer Lyons' chart, she's just a bad slip... Read More

Cholesterol Prescription Medications Can Kill You

While there are numerous options for people to lower cholesterol... Read More

Sinusitis: Sinus Infection Deals a Corporate KO

Sinusitis and Sinus Infection Starts with a Little SniffleYes, I... Read More

Celebrex Side Effects Lawsuit Lawyer

The Food and Drug administration urges people to stop taking... Read More

Family Notification in Seven Quick and Easy Steps

The Seven Steps to Successful Notification is an easy-to-use system... Read More

Prescription Drug Benefit Cost Understated by $324 Billion!

When the legislation was passed for Bush's prescription drug benefit... Read More

New Antidepressant Developments and Approvals

New antidepressant development, until fairly recently, was at best a... Read More

Alzheimers Toxin May Be Key To Slowing Disease

Australian scientists say they have identified a toxin which plays... Read More

Orphan Drugs: Hope Where There Is Little or No Hope

NEW YORK, N.Y., February 18, 2004 ? On a visit... Read More

Finally...Affordable Prescription Medication without Insurance.

If you are like many Americans, you are without health... Read More

What is Going On With Pharmacies in Canada

There is a large amount of talk lately in regard... Read More

rX My Heart and Hope to Die

This must be a mistake! How could his drug costs... Read More

A Closer Look at Neck Pain Relief

Neck pain afflicts many people at some point in their... Read More

Whats a Good Arthritis Medicine for Me, Doctor?

Pain is the body's warning signal that something is wrong.... Read More

Treating Lazy Eye in Older Children

Many eye doctors believed until recently that if a child's... Read More

High Cholesterol Prescription Medications Can Kill You

The World Health Organization declares that heart disease is the... Read More

Every Pharmaceutical Drug LEECHES Nutrients From Your Body

Are you currently on one or more pharmaceutical drugs? Perhaps... Read More

The Pharmaceutical Drug Cartel and the FDA

According to the Los Angeles Times, the California Association of... Read More

A Compelling Look at Pain Relief

If your back aches when you're loading groceries in the... Read More

3 Facts Everyone Should Know About Stem Cells

Cord BloodCord Blood is the blood that remains in the... Read More

The Ease of Using a Motorized Wheelchair to Improve Mobility

No person likes to feel housebound and dependent on others.... Read More