Living with
Rheumatoid Arthritis(RA)
What is RA?
Rheumatoid
arthritis (RA) is a chronic autoimmune disease that causes symmetric, erosive
synovitis (inflammation of the synovial joints, particularly painful with
motion). Synovitis can cause joint destruction and deformity. (1, 2)
 |
| (5) |
Who does RA affect?
1% of the adult population (3)
Treatment of RA? (4)
1. Medications-
NSAIDS-pain
relief and reduce inflammation
Steroids-pain
relief, reduce inflammation and slow joint damage·
Disease-modifying
antirheumatic drugs (DMARDs)-slow the progression arthritis and save joints and other
tissues from permanent damage
Immunosuppressants
TNFα
Inhibitors- pain relief and reduce stiffness
· Other drugs
2. Physical Therapy-Learning how to move
joints in a different way
3. Surgery- Total joint replacement, tendon
repair and joint fusion
Now the basics of RA are understood, but what is
like to live with RA?
The
reason I'm writing about RA is because my mother suffers from the disease. What
is most saddening and remarkable is my mom is in constant pain and never
complains. She has tried every type of medication, physical therapy and
multiple surgeries.
It
is a constant battle to figure out the amount of steroids and NSAIDs my mom has
a take to balance the effectiveness and side effects. Every
medication has side effects like NSAIDs cause ringing in the ears, which is not
only annoying but also causes difficulty sleeping. Constant intake of NSAIDs can also
cause thinning of the blood and ulcers (remember COX1 pathway?) Steroids cause
weight gain and thinning of bones. My mom has also tried immunosuppressants and
ended up in the hospital from side effects on the medication (which my mother
being stubborn I had to threaten a 911 phone call to get her to the ER). Not to
mention she works in the oncology department at Children's Hospital
Colorado and being immune compromised there is not safe for the
patients or my mother. She has also had four different surgeries on joints to
repair damage and more are planned.
All
in all, RA is a difficult disease to live with because you are in constant
battle to determine effective treatment without severe side effects. When we
are physicians, dentist and PA's I think it's incredibly important to consider
side effects, the cost of the treatments the patient's lifestyle before we
prescribe a treatment.
References:
1.
R.C.
Lawrence, C.G. Helmick, F.C. Arnett, R.A. Deyo, D.T. Felson, E.H. Giannini et al. Estimates of the prevalence of arthritis and selected
musculoskeletal disorders in the United States Arthritis Rheum, 41 (1998), pp. 778–799.
2.
Hochberg
M. Adult and juvenile rheumatoid arthritiscurrent
epidemiologic concepts Epidemiol Rev, 3 (1981), pp. 27–44.
3.
Khanna
D, Arnold EL, Pencharz JN, Grossman JM, Traina SB, Lal A et al. Measuring Process of
Arthritis Care: The Arthritis Foundation’s Quality Indicator Set for Rheumatoid
Arthritis. Semi Arthritis Rheum, 35:4 (2006), pp. 211-237.
4.
http://www.mayoclinic.com/health/rheumatoidarthritis/DS00020/DSECTION=treatments-and-drugs
5. https://www.mountainside-medical.com/product_images/uploaded_images/Arthritis.jpg
Your mom is a strong woman.
ReplyDeleteI was wondering what kind of medication she took that got her hospitalized?
Also, it seems that all current medications including tocilizumab, methotrexate, adalimumab,all have large side effects. Surgeries have it's complications. Have you guys ever looked into stem-cell treatment? This report by Snowden et al. seems to indicate good results worldwide, at least for a while.
http://www.jrheum.org/content/31/3/482.short
Thanks. I agree, she's more than incredible. She took a drug called Immurin, which caused a bowel obstruction and she ended up in the hospital for two days. I don't believe my mother would ever do a stem cell treatment because of the time she would need to be off of work and the fact she doesn't think her RA is severe yet. But maybe in the future she will when not if her RA becomes worst.
ReplyDeleteThis comment has been removed by the author.
ReplyDeleteI have witnessed first hand the ups and downs of treating this deliberating disease, but the good news is it can go into remission. RA runs in my family both my aunt, and my mother have the disease. Both them went through methotraxate treatment to reduce T-cell levels, and they both had nasty chemotherapy side affects. My mother said it was like have an out body experience. Fortunately, they both got on Remicade, a TNF-alpha blocker, and that had less side affect. But , still they were extremely prone to infection because of the comprised immune system and they have built up a small resistance to the drug. My mother doctors was always adjusting dosage, which also impacted her daily physical function. Currently, my mother is in remission, while my aunt is not. My aunts hands look like textbook RA and is still currently on treatment. The big difference between the two is diet. My mom eats tons of vegetables, spinach in particular, and takes high doses of cod liver oil and flax seed oil to boost Omega-3. Your Omega 3 to Omega 6 ratio is critical for preventing chronic inflammation. Also she minimize gluten, meat, GMO foods and dairy to reduce immune reactivity. So, I would add diet to forms of treatment for RA. Hopefully, your mother able to go into remission.
ReplyDeleteI had never heard that a person could use their diet as a form of treatment for rheumatoid arthritis, so I looked into the exact effects fish oils have on the disease. Studies with animal models have shown that fish oil slows the development of arthritis and reduces the severity of the disease. Studies on humans have shown that fish oils have a fairly steady but moderate decrease in joint pain and swelling. Now I would to completely agree that a diet could be used as a moderate form of treatment for RA.
ReplyDeleteMiles, E., & Calder, P. (2012). Influence of marine n-3 polyunsaturated fatty acids on immune function and a systematic review of their effects on clinical outcomes in rheumatoid arthritis. The british journal of nutrition, 107, S171-184.
Lindsey, my mom also suffers from RA. It started about 7 or 8 years ago, when she was only in her early forties. Since then, it has gotten worse and worse and she is now not only dealing with rheumatoid arthritis, but several other autoimmune diseases: Sjögren's syndrome (immune cells attack the mucous membranes in eyes, nose, mouth - my mom doesn't make tears anymore), fibromyalgia, and interstitial cystitis. She is also constantly in pain and I am so thankful that I came across this blog because I am definitely going to let her know that changing up her diet and taking supplements such as cod liver oil and flax seed oil could potentially reduce the pain. I also looked up the effect of exercise on RA patients because I am a strong believer in exercise and its effects on alleviating some symptoms. I found an article by Ballet et al. (2010) that looks at stable RA patients and the effect of aerobic exercise. They found that aerobic exercise is not unhealthy and did in fact show a small improvement in some of the symptoms of RA patients. In patients with RA, like my mom, even the smallest relief is a blessing.
ReplyDeleteSorry, forgot to add my reference:
DeleteBaillet A, Zeboulon N, Gossec L, Combescure C, Bodin LA, Juvin R, Dougados M, Gaudin P. 2010. Efficacy of cardiorespiratory aerobic exercise in rheumatoid arthritis: Meta-analysis of randomized controlled trials. Arthritis Care and Research. 62(7):984-992.
Candice,
ReplyDeleteMy mom first had Sjogrens and then developed RA. My mom currently takes those eye drops everyday and has plugs in her eyes as well. Steven thanks for the diet comment. I will definitely tell my mom!