Did You Hear?

A new bill introduced in the U.S. Senate May 6th will strengthen efforts to prevent, control and cure arthritis – the nation’s most common cause of disability. Introduced by U.S. Senators Barbara Boxer (CA), Kit Bond (MO), and Ted Kennedy (MA), the legislation will address this disease that impacts more than 46 million adults and nearly 300,000 children.


The Arthritis Prevention, Control and Cure Act looks to:

• Enhance CDC public health activities related to RA
• Expand NIH programs relating to Juvenile RA
• Establish JRA population database
• Enhance support for training programs
• Establish a loan repayment program for pediatric rheumatologists to address the severe shortage of such health care providers

The Arthritis Foundation urges Americans, both young and old, to show support for this bill by contacting their members of Congress. Visit the Arthritis Foundation Web site at www.arthritis.org/advocacy.php to become an advocate.

This is a debilitating disease that costs the U.S. economy $128 billion annually in medical costs, accounting for 44 million outpatient visits, 992,100 hospitalizations and 9,367 deaths each year.

A little about that Bastard Ray: Rheumatoid Arthritis (RA) is a chronic autoimmune disease that is 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. Although joint problems are the main symptom of RA, it can also have serious impact on the eyes, heart, lungs, and skin. RA can affect males and females of all ages with various degrees of pain and damage.

Many medical treatments for RA have been modified from their original use.

Some patients are able to manage pain with over-the-counter Non-Steroidal Anti-Inflamatory Drugs (NSAIDs), such as ibuprofen (e.g., Advil), while others require prescription NSAID intervention, such as celecoxib (e.g., the COX-2 inhibitor Celebrex) … “COX” stands for cyclooxygenase, which is an enzyme that causes pain and inflamation in the human body; for this reason, NSAIDs are generally the first line of defense for RA sufferers.

Although NSAIDs can do a great job alleviating pain for awhile, they cannot control the course of this disease, for which there is no cure. Treatment for symptom control begins in the form of chemical Disease-Modifying Anti-Rheumatic Drugs (DMARDs), such as low doses of the immunosuppressant methotrexate (which in very high doses is a form of chemotherapy), or cyclosporine, which is more commonly used to keep patients from rejecting donated organs. These drugs serve to slow the progression of the disease and to reduce indications.

The most recent DMARDs to hit the scene are called "biologics", because they have been genetically engineered from human and/or mouse antibodies and act as Tumor Necrosis Factor (TNF) inhibitors. TNF are like the traffic police of the bloodstream, directing the flow of protein vehicles that, left uncontrolled, can cause various immune system accidents; in the case of RA, such accidents lead to inflammation. The biologic DMARDs, such as adalimumab (e.g., Humira) keep the TNF "police" from opening the bloodstream "freeway" to high volumes of inflammation-causing protein "vehicles". This latest group of DMARDs have brought the possibility of complete remission of both symptoms and disease progression to patients.

A healthy diet is also an important factor in controlling RA, but no standard has yet been developed, although general ground rules include:

1. Fruits and green vegetables are highly recommended, as is a minimum of 40 ounces of water daily
2. Patients should strictly limit the amounts of root vegetables (e.g., potatoes) grains, dairy, rice, and processed foods eaten
3. Patients should eliminate red meat, corn, corn by-products, and nightshades (e.g., mushrooms and eggplant), from their diets

Also, there are food requirements based on which medications the patient is using; for instance, someone taking methotrexate must also take prescription amounts of folic acid, and is warned to severely curtail alcohol consumption, as methotrexate can cause liver damage. This is especially stressed as patients have been known to use excessive amounts of alcohol to dull the pains caused by RA.

Getting plenty of sleep is vital; one of the symptoms of RA is chronic fatigue. Those with RA are unable to skip sleep and make it up throughout the week, as a healthy person may. In general, while a healthy person needs an average of six to eight hours sleep a night, one with RA may need ten to twelve hours in every 24 hour period. In addition, most sufferers experience a period of stiffness upon waking every morning due to the lack of movement during sleep; stiffness can last anywhere from a few minutes to more than three hours.

Many RA sufferers learn the benefits of taking naps and slowing down (e.g., giving themselves more time to accomplish goals, whether they’re career-oriented, or simple house cleaning); RA requires those diagnosed to come up with a “new normal”.

Giving the body with RA time to rest and relax without doing a great deal of high-impact or joint-stressing moving around helps. It is also extremely uncomfortable for those with RA to sit or stand for long periods of time. Low-impact mobility exercise is essential; the body must be kept flexible with a regular regimen or general stiffness can result in permanent lack of mobility.

Because RA is an autoimmune disease, those who have been diagnosed need to stay as healthy as possible, which means staying away from “sick” people (i.e., a friend with a cold, the flu, or some other viruses), and should get a flu shot annually. The medicines discussed earlier are immunosuppressants, which cause a marked decrease in the effectiveness of the patient’s immune system. Someone with a non-compromised immune system may have a common cold for four days, whereas one with RA may be ill for three weeks. The RA sufferer cannot quickly bounce back from minor illness, but can rapidly succumb to major illness. Something that can take multiple treatments and many months to cure in a “normal” person can actually be fatal for one with a compromised immune system.

At this time there is no definitive “why” that causes RA, although there is a high incidence of auto-immune disease in family histories, and some studies have linked severe infection or such activities as smoking to disease onset. There is no typical geographic set, although women are far more likely to be diagnosed with the disease than men. There is even a version that attacks children, called either Juvenile Rheumatoid Arthritis (JRA) or Juvenile Idiopathic Arthritis (JAI).