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Over my life I’ve had to make several trips to the emergency room. Most of these were from acute situations, occurred during childhood, and involved accidents from wild, boyhood behaviors. One time I was jumping a ramp on my bike and my jaw landed on the sidewalk resulting in six stitches and a permanent scar. But yesterday I found myself at the ER for a chronic situation that got out of hand.

I’ve lived with neck pain over the past couple of years and my rheumatologist had an x-ray done in 2012. Nothing significant was seen. Pain continued to gain in intensity and it began to radiate down my neck into the shoulders. I assumed that it was muscle tension and sometimes took muscle relaxants at night. About a month ago I began to notice tingling in my left fingers. I was getting physical therapy for my right elbow and the therapist said that it was likely caused by inflammation in my elbow and wrist (cubital and carpal tunnel syndrome – common in RA). The pain continued to grow in intensity and the past week it got to the point where it felt like holding up the 12 pound bowling ball which is my head was just not possible. On Thursday I left work at 3:00 in the afternoon with such intense pain that I could barely drive. I made it to my home city and actually pulled into the hospital parking lot wondering if I should walk into the emergency room. I called my rheumatologist’s office and told them what was happening. They made an appointment for the next morning and said that I should go to the ER if I felt it was needed. I eventually drove home and tried to nurse my neck. Even after taking muscle relaxants, sleeping was not possible and I woke up at 3 in the morning. I barely made it to the appointment with my rheumatologist in the morning. After a few moments talking and examining me, she looked directly me in the eye and said that I needed to go to the ER because it was clear that I needed immediate pain management and a diagnosis of what was going on. She offered to call an ambulance but I told her I would drive myself – call me crazy or stubborn.

Screen Shot 2014-04-11 at 3.37.32 PM (1)I got to the ER and walked in. They immediately took me to an exam room and began to get vitals and ask me what was going on. The doctor prescribed major pain meds via IV and they had to double to dose after the first one didn’t help much. He ruled out infection and accident and suspected neck problems from rheumatoid arthritis. He ordered an MRI on my neck. The intense pain made it tough to lie still in the MRI machine. The MRI revealed spondylosis (degenerative arthritis), two herniated discs pushing into the spinal cord, and bone spurs pushing into radiating nerves (see MRI picture). The cause of the pain and tingling was finally revealed. The ER doctor actually called my rheumatologist and had a conversation with her about the situation. He sent me home with pain meds and steroids. I have an appointment Monday morning with a spinal surgeon to determine next steps.

Most people think of RA only impacting small joints like the fingers. In fact, the ER doctor mentioned that when first talking to me but I told him that most of my large joints including ankles, knees, hips, elbows, and shoulders show RA induced damage. Now it appears my neck has also been impacted. According to a 2006 article in the journal Rheumatology, “The polyarthropathy of rheumatoid arthritis affects the joints of the spine, and particularly the upper cervical spine.” The lesson from this situation is don’t ignore neck pain if you have RA!

 

In the recent RA in America poll reported on this website, 41% of respondents indicated that they had partaken in physical therapy and 11% in occupational therapy as part of their treatment. Personally, countless hours have been spent in my local physical therapy facility due to the impact of rheumatoid arthritis. These experiences began as the consequence of ankle problems that ended up resulting in three surgeries over a three-year period. Physical therapy was prescribed after each surgery and it helped in the recovery process. The therapy usually lasted a few months until I was able to continue the strategies learned at home on my own.

I’m currently seeing a certified hand therapist (CHT)…read the rest at http://rheumatoidarthritis.net/living/another-day-at-the-pt/

A group of researchers at the Max Planck Institute of Immunobiology and Epigenetics in Germany released research results that implicate the lack of a protein in B lymphocytes in autoimmune diseases including rheumatoid arthritis. The original research was published in the Journal of Experimental Medicine.

In reporting on this research, an article published in a popular press outlet in Germany used the headline “German Scientists Discover ‘Anti-Arthritis’ Protein”. Such a headline pulls in the reader thinking that a cure for RA is just around the corner. However, such a response is much too premature and all too common when reading about research being conducted on autoimmune diseases. The researchers found a protein called PTP1B was linked to autoimmunity processes. As with most initial studies, the first part of the research was conducted with mice and results don’t always extrapolate to people. These researchers did, however, follow-up with examining RA patients in a clinic. This protein is not newly discovered as scientists connected it to metabolism and insulin years ago. The PTP1B protein is also connected to B cell activating factor (BAFF) which scientists implicated in RA processes and connect to tumor necrosis factor (TNF) which has been the target of many RA treatments for years.

Personally, the most interesting part of this research is the role of B cells in rheumatoid arthritis since I am currently taking Rituximab which reduces the B cells in the body. In reporting the results on the university website, the scientists noted the potential role of Rituxamab in impacting the PTP1B protein in the following statement,

“The B-cells produced after the Rituximab therapy possess similar amount of the PTP1B protein as cells in healthy people. This may contribute to the less severe autoimmune reaction.”

While this research is interesting in terms of potential interest of determining why Rituxan works to treat RA, there remains much speculation about the biochemical processes involved and new treatments based on the role of the PTP1B protein remain hypothetical and likely many years away. As one of the scientists stated,

“Finding out how the protein works was an important discovery, but it doesn’t come with a solution to help heal arthritis, Michael Reth said. For that, scientists would need to artificially stimulate the PTP1B protein, and they are yet to find a simple way to do that.”

For thousands of years and across many cultures, marijuana, or cannabis, was touted as possessing medicinal properties. And its use for both medicinal and recreational purposes is gaining in popularity in recent times. Some activists are advocating its use for rheumatoid arthritis. My desire is that RA patients will carefully consider all treatments for their disease. The topic must be raised in public forums and from scientific perspectives. I realize that this article will likely bring about a slate of responses, both for and against. Such is a nature of controversial topics…

…read the rest of this post at http://rheumatoidarthritis.net/living/medical-marijuana-a-viable-option-for-the-treatment-of-ra/

When first diagnosed with RA over five years ago, I was prescribed oral methotrexate (MTX). After a month of taking the pills, I felt terrible and was basically non-functional. It felt like a truck ran over me as I had no energy, felt sick at my stomach non-stop, and had headaches. The RA symptoms were bad enough but this just added insult to injury. My rheumatologist finally told me that I clearly could not tolerate the drug and to stop taking it. The side effects subsided within a few weeks.

Several years later, and with a different rheumatologist, I asked about taking MTX injections because I was desperately trying to find a treatment combination that worked. It was recommended to add MTX with the biological medicines I was taking as the combination of the two typically produces better results. I started take methotrexate via weekly self-injection and found that the nausea side effects were much less than with oral pills. I seemed to tolerate the MTX much better when injecting it and adding both folic acid and leucovorin. I rarely felt nausea and did not loose any hair.

But an increase in migraine headaches over the past year coincided with the time I started taking MTX. While not one of the more commonly reported side effects like nausea or hair loss, headaches can come from taking MTX.[i] [ii] As my neurologist stated, the causes of the migraines are likely based on multiple factors including genetics, my fight with RA, and the medicines I take. During the past few months when the headaches increased in number, I completely stopped taking methotrexate in an effort to eliminate any possible triggers. We’ve been able to reduce the number of migraines through the use of gabapentin, a drug used for neuropathic pain, and botox injections (no, I don’t look any younger!). My rheumatologist suggested that I start retaking methotrexate by beginning with low doses initially and then increase back up to the dose I was taking before. I waited until I had been headache free for two weeks and then injected MTX. Within 48 hours I began to get migraines and fought off four bad headaches over the next five days. While it’s hard to determine direct cause and effect, this was enough for me to wonder if MTX was indeed a migraine trigger. I did not inject MTX the next week and did not have any bad migraines. I contacted my rheumy and she suggested I just stop MTX altogether. The good news is that during this time, Rituxan infusions that I started last September were starting to work at controlling my RA and this was during the time I had stopped taking MTX.

So for the time being, I’ll just stick with Rituxan as my main RA treatment. And I’ll be sitting in the infusion center this Wednesday starting my second series of doses.

Dr. Robert Plenge is one of the world’s foremost rheumatoid arthritis researchers. He recently led a team of international scientists who conducted a large genetic study about RA. They discovered 40 new genetic areas related to increased risk of RA that may eventually led to new treatments. These results were published in the prestigious scientific journal Nature. Dr. Plenge agreed to participate in an exclusive question and answer interview with Rheumatoidarthrititis.net Patient Advocate Andrew Lumpe.

Q. What drove you to delve into the mysteries of rheumatoid arthritis? 

A. As a practicing clinical rheumatologist…

…read the rest of the interview at http://rheumatoidarthritis.net/living/an-interview-with-world-renowned-ra-researcher-dr-robert-plenge/

RheumatoidAwarenessDay2-150x150February 2 is Rheumatoid Awareness Day. In honor of this day, I put together a list awareness dreams…

  1. I dream of a day when all rheumatologists treat-2-target and more patients achieve or get closer to clinical remission.
  2. I dream that autoimmune diseases including rheumatoid disease receive as much or more research funds than other more popular diseases including cancer and heart disease (long ways to go there).
  3. I dream of a time when I never have to hear dumb comments like, “Oh, I have RA in my little finger” or “You’re too old to have RA.”
  4. I dream of a time when rheumatoid disease, which impacts millions of Americans, receives a most favored status in terms of awareness and funding.
  5. I dream of more effective treatments and ultimately a cure for this insidious disease. While biologicals have helped many, too many continue to suffer.
  6. I dream of a time when all primary care doctors know when they observe symptoms of rheumatoid disease and quickly refer patients to rheumatologists.
  7. I dream that all rheumatologists will treat rheumatoid disease aggressively and monitor carefully.
  8. I dream that all rheumatology researchers will take the patient perspective into account when designing, carrying out, and reporting research.
  9. I dream that genetics can be used to play a role in personalizing treatment options.

You can read other blogger’s post about Rheumatoid Awareness Day at http://rawarrior.com/what-would-rheumatoid-awareness-mean-to-you/

Check out the Rheumatoid Awareness Day Facebook Page.

Read more about the day at the Rheumatoid Patient Foundation site.

Get involved and spread awareness about Rheumatoid Disease!

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