New Drugs Offer Hope To Rheumatoid Arthritis Patients

By Nancy K. Crevier

What has really revolutionized the treatment of rheumatoid arthritis (RA) in the last five years, believes Dr Kenneth Miller, Newtown resident and a rheumatologist with Arthritis Associates of Connecticut and New York in Danbury, are the biotechnology products. Drugs such as Enbrel, Humira and Remicade are paving the way for major advances in the treatment of this debilitating chronic joint disease, as is the practice of early intervention.

Where once doctors waited for advanced symptoms of the disease to appear before beginning drug therapy, his 25 years of experience in the field has shown him that early, aggressive treatment benefits RA patients. Dr Miller’s practice has also taken part in studies for some of the cutting edge drugs. Retuxin and Abatecept are two more of the new drugs likely to be approved in the next few months, he said. The new drugs may be what RA patients who have had poor results with other therapies are seeking.

Rheumatoid arthritis may be the result of an abnormal immune system response resulting in inflammation of the joint lining, although its exact cause is unknown. According to The Arthritis Foundation, the genetic marker HLA-DR4 may indicate a propensity toward RA. More than two thirds of RA-positive Caucasians carry this genetic marker, leading researchers to believe that it is of genetic origin. Dr Miller suspects that RA is a genetic disease with environmental factors that exacerbate it.

Because it is a systemic disease, rheumatoid arthritis is capable of affecting the health of other organs in the body. Those afflicted with the disease can suffer from long-term joint damage leading to a loss of function and disability, as well as having to deal with on-going pain.

Early intervention is crucial to controlling RA, says Dr Miller, and must be tailored to the individual. “Most patients start to get damage within six months to two years [of the onset of the disease]. That is the window of opportunity to start therapy.”

Symptoms of RA are highly variable, but most common is joint pain in smaller joints of fingers, hands, and wrists. The pain is usually symmetrical. If a joint hurts on one hand, the corresponding joint on the other hand will most likely hurt, as well. Fatigue, morning stiffness, flulike symptoms, muscle pain, and a loss of appetite along with joint pain can indicate the presence of RA. A long-lasting joint inflammation should be diagnosed sooner, rather than later, suggests Dr Miller.

“Any chronic joint stiffness that lasts more than 30 minutes and goes on for at least six weeks should be evaluated,” he said.

Rheumatoid arthritis affects more than 2.1 million Americans. Arthritis Associates alone sees approximately 1,200 patients. It strikes at all age groups, but the majority of RA sufferers are women between 30 and 50 years of age. Because female RA patients tend to go into a remission of symptoms during pregnancy and also find an increase in symptoms following birth, it is feasible that female hormones play a part in the development of RA. Scientists also believe that those who are susceptible to RA may have an abnormal reaction to an infection or traumatic event that triggers the disease.

Janice, a 51-year-old Connecticut schoolteacher, was diagnosed two years ago with RA. Following a car accident, she awoke one night to a fiery feeling in her wrist and arm, along with numbness. “I couldn’t even hold a pen or a cup of coffee without my hand shaking,” she says. The disturbing sensation propelled her to make an appointment with her doctor, who subsequently referred her to a rheumatologist. A highly elevated RA factor confirmed the diagnosis.

The most difficult thing about RA for this busy team leader, who dedicates many hours outside of the classroom to scheduling and planning for the other teacher/team members, is dealing with fatigue. “I have to parse out my energy to get done the things I need to get done,” she says. “When I’m home, I take a nap.” By the end of a school day, though, she has neither the time nor energy anymore to commit to cooking or gardening, two things she loved to do before RA set in.

Modifying the lifestyle is something that RA patients must do to accommodate the disease. Janice, in addition to curtailing gardening and cooking, no longer takes her two Irish water spaniels on long hikes. “I’d say I walk the dogs 50 percent less than I used to,” she says. She is also very careful now about lifting and carrying. She says, “You don’t realize how much stress you put on your joints just doing that.”

Frustrated RA patients, who often must try many different treatments for the best relief and control of their symptoms, may turn to alternative medicine. Acupuncture and acupressure are alternative therapies that profess to provide relief for arthritis sufferers. It is thought that these ancient Chinese techniques help the body to release endorphins, increasing a sense of well being. Massage and pain relief treatments can be helpful in controlling the pain for people who suffer from arthritis that is not inflammatory in nature, but Dr Miller does not believe they are particularly successful in RA patients.

RA patients discouraged by conventional healing frequently seek natural supplements and herbs. Dr Miller cautions his patients about herbal therapy. Herbal therapy is unproven, he says, adding, “Many of the Chinese herbal imports are not controlled. I would caution anyone from buying anything from overseas. Some of my patients will tell me they have had improvement with some of the Chinese herbs. They might contain adrenal extracts, which are basically steroids. The adrenal stuff is dangerous to take when you don’t know what you are taking.” It is vital that patients inform their doctor if they are using herbs or supplements in addition to, or instead of, their prescribed medicines.

When patients drift away to experiment with alternative therapies, what concerns this rheumatologist is that effective, conventional therapy is forestalled, resulting in more damage to joints because the disease has not been controlled. While it might go into remission for a period, RA is an ever-present, chronic disease, with no cure. Managing it is an on-going process for those afflicted by the disease to prevent crippling damage.

Janice initially turned to naturopathic therapy when diagnosed with RA. Reading about her disease, she realized that herbal supplements often treat only the symptoms, but not the progression, of the disease. She opted to turn to conventional therapy and the hope that newer drugs on the market could provide relief and stymie the progression of the RA. “I couldn’t bear the thought of more joint damage,” she says.

Her medicine cabinet is a small pharmacy these days. Methotrexate, also used to treat cancer, is part of her regime, as is hydroxycholoroquinine. High dose, prescription Ibuprofen is necessary keep the inflammation at bay so that she can do her job, and sleeping pills allow her to rest when her joints hurt. She also takes calcium with vitamin D to keep her bones strong. Her doctor indicated she could continue to use the herbal supplements in addition to conventional medicine, but as she points out, the supplements are not inexpensive and the cost for most is not covered by health insurance.

“I’m afraid to ask ‘What is the future?’ Probably the RA would get worse without medication,” she says.

“It [RA] does affect your spirits,” Janice adds. “If you allow it to, you can get into the ‘Oh no, another day I have to get up,’ mindset. Attitude is so important.”

With individualized treatment applied as early as possible, a good, working relationship with a trusted rheumatologist, and an arsenal of new drugs being utilized, the progress of RA may be thwarted. A healthy, productive life is possible.