A Blood Test for RA Before Symptoms Appear?

Swedish scientists recently published a study in the American College of Rheumatology (ACR) journal Arthritis and Rheumatism in which they tested blood samples of individuals prior to being diagnosed with RA and compared them with a control group.[i] They found significantly higher levels of inflammatory cytokines in people who were later diagnosed with RA. The researchers noted,

Individuals in whom RA later developed had significantly increased levels of several cytokines, cytokine-related factors, and chemokines representing the adaptive immune system; after disease onset, the involvement and activation of the immune system was more general and widespread.

Perhaps research like this could lead to the development of screening tests for individuals who may be at higher risk of developing RA. Such tests could help lead to early identification and treatment for those who get RA.

http://www.flickr.com/photos/neeta_lind/

These researchers were also able to hone in on the cytokines that may play a role in initiating RA. Interestingly, the levels of various cytokines changed over time as diagnosis occurred and as the disease progressed. They noted that later in disease progression, the notorious cytokine TNF is not as abundant as earlier. This finding may have implications for the popular TNF blocker biological medicines like Enbrel and Humira.

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[i] http://www3.interscience.wiley.com/cgi-bin/fulltext/123235557/HTMLSTART

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Is RA Under Control?

Things appear to be looking up this week. El niῆo brought unusually warm and sunny weather to Seattle. This allowed for an entire day spent outdoors catching up on some neglected chores like car repairs, disposing of the Christmas tree, and trimming the dog. Unfortunately, the weather patterns may wreck havoc on the upcoming winter Olympic games held just a 100 miles north in Vancouver, BC. There hasn’t been much fresh snow in a while and temperatures are above normal (see article).

http://www.flickr.com/photos/tgillin/

These chores may not have been possible a few months ago…or at least tackling them all in an entire day. While joint pain, stiffness, and fatigue continue to linger around, they are much diminished and don’t distract. Four months of Cimzia injections appear to be putting RA into a state of check. Tracking of symptoms reveal a steady decrease over time. My rheumatologist was quite pleased and indicated that there would not be a need for another office visit for three months. That’s good news since monthly visits were the norm for quite a while. My calendar and bank account are also grateful. Whether or not it will be possible, my goal is to get down to only one medication within the next month…Cimzia injections.

While visiting with the gastroenterologist last week, he was curious about my use of Cimzia. He treats patients with ulcerative colitis and regularly prescribes Humira. Cimzia is also approved for ulcerative colitis but he said that his patients refuse to take it because “it hurts too much.” I laughed because I prefer the once a month injections. No pain, no gain!

If there were better conditions at the ski resorts, I would’ve went skiing on this MLK holiday instead of doing chores. In the meantime, I’ll take the sunny skies and RA symptoms that appear to be under control.

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Raise your Right Hand…”I Vow to Never Take NSAIDs Again”

Just as RA symptoms seem to be under better control with Cimzia, other related medical issues creep in. This time it’s lingering side effects from NSAIDs.

Most of us over 40 remember those wonderful tasting, chewable orange aspirin pills. The distinct taste remains ingrained in memory. These days, sugary, fruity liquid versions of ibuprofen sit on the shelves of most parents. Such begins many people’s experience with NSAIDs. As a side story, when I was two years old, I ate a bunch of those orange pills and told my parents that “I took all of my medicine.” The story ends with a stomach pumping at the hospital and a federal requirement for child-proof medicine bottles.

Non-steroidal anti-inflammatory drugs (NSAIDs) are a commonly prescribed treatment for RA inflammation (see earlier post). In addition to taking aspirin as a child, I’ve taken massive doses of ibuprofen (up to 1,600 mg a day), tried naproxen, and celebrex during earlier stages of RA. Once a rheumatologist got involved, meloxicam and salsalate were tried since they are believed to cause less stomach problems. Meloxicam lasted two days before the telltale signs of stomach upset began so the anti-inflammatory effects were never felt. During the first ten days, salsalate did wonderful things for RA induced inflammation. Then one fine day, unspeakable stomach pain started. Use of acid blockers helped but things didn’t seem to get better. Finally, after almost four weeks of gastric suffering, I decided it was worth visiting a gastroenterologist. Within five minutes he suspected an ulcer and scheduled an endoscopy of the upper GI tract the next day. While the scope found irritation of the stomach and esophagus, no ulcer was visible. The doc intimated that an ulcer may have been present earlier but had healed. That was good news indeed.

This entire set of experiences are not surprising since the side effects of NSAIDs are clearly documented.

These effects are dose-dependent, and in many cases severe enough to pose the risk of ulcer perforation, upper gastrointestinal bleeding, and death, limiting the use of NSAID therapy. An estimated 10-20% of NSAID patients experience dyspepsia, and NSAID-associated upper gastrointestinal adverse events are estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United States, and represent 43% of drug-related emergency visits.[i]

Wow! That statement is frightening. On top of GI problems, NSAIDs are also linked to an increase in heart attacks and stroke. [ii]

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Many arthritis patients are able to tolerate NSAIDs just fine and find relief from their use. But I must fall under that 10-20% who cannot. Therefore, “I vow to never take NSAIDs again!”

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[i] http://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drug

[ii] http://www.webmd.com/rheumatoid-arthritis/guide/nsaids-rheumatoid-arthritis

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Cimzia and RA – 4 Months of Treatment

It was interesting travelling during the holidays and needing a Cimzia injection for RA. Not knowing how it would all work out, a quick call to the specialty pharmacy resulted in a pleasant response and a promise to deliver the package of syringes (packed in ice of course) to my in-law’s house more than two thousand miles away in the blizzard conditions of the Midwest. They even included a sharps disposal box!

Snowy Drive, http://www.flickr.com/photos/ozute/

The package couldn’t have come any sooner as the three or so days before the injection, the symptoms of RA began to raise their ugly head. I resorted to take a 4 mg pill of methyprednisolone one morning in a feeble attempt to knock down inflammation. We were in a mad rush out the door to travel to a nearby city to attend a sporting event when the UPS truck navigated the foot of snow and ice to drop off the package. It’s interesting to note the responses from family members when they saw two large syringes. I think it drives home the seriousness of the disease.

Off in the car we jumped with the Cimzia in hand. It needed to warm to room temperature before injecting so 20 minutes down the road I asked my brother-in-law to pull off the highway so I could do the deed. My oldest son, who had never seen me inject before, was quite intrigued with the process. After four times through this routine, it seems to get easier except for those “bleeders” the last two times. I must have hit a vein somewhere.

A daily journal of energy levels, joint problems, and other observations help track conditions (see earlier post). On a scale of 1-10, I’ve been averaging about a 6 for the past 2 ½ months. During that time, I’ve never really dipped below 4 or above 8. I am coming to realize that this is probably success. While there are still ups and downs demonstrated in a variety of ways (including one infection), and RA is always lingering around, hope abounds that perhaps Cimzia is helping. Realizing that RA and treatments can be a moving target, I’ll count my blessings for now.

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Natural Weapons Against RA

This post concludes the series on Weapons in the War Against RA Inflammation. The focus on inflammation is due to the fact that RA is a disease of chronic inflammation. Thus far we’ve  examined Conventional Weapons – NSAIDs, Nuclear Weapons – Steroids, Chemical Weapons– Methotrexate and others, and Biochemical Weapons – biological drugs. The arsenal in the war is vast but comes with pros and cons. 

The historical medical approach to treating RA seems to center on the use of drugs. Out of frustration with the lack of success of treatments, RA sufferers often look for other cures on their own. Indeed, some natural approaches to reducing inflammation may be worth trying. 

http://www.flickr.com/photos/amitbelani/

I classify natural weapons against inflammation into two categories, Ingested Substances and Physical Treatments. Ingested Substances include supplements, diet, and herbs. It stands to reason that one should be careful what you put into your body. Eating unhealthy food is unwise in general and certain foods even increase inflammation.[i] [ii] Some supplements like fish oil may even reduce inflammation.[iii] There may be interactions between supplements and medications so be sure to tell your doctor about everything you take. A few months ago, in response to reading about a possible relationship between diet and autoimmune diseases (see earlier post), I eliminated dairy and gluten for one month. I didn’t notice any difference before, during, or after this elimination diet. I’m glad because a daily latte is a must (maybe caffeine should be included on the supplement list)! I still try to eat as healthy as possible. I also take fish oil and use flaxseed on a regular, but not daily, basis. 

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Physical treatments include procedures and substances applied externally and may include heat or cold, massage, lotions, stress management, physical therapy, exercise, and prayer. [iv] [v] Some of these treatments like heat, massage, and lotions have short term effects. There’s nothing better than spending some time in my hot tub each evening. And I’ll apply a topical to a flaring joint periodically. Stress management is a wise life skill for anyone but RA sometimes causes us to slow down. I think that’s our body’s way to speaking to us that it needs rest. I’m still struggling with that exercise thing and there are many conflicting views about it and RA. I regularly receive prayer for my RA symptoms. 

An examination of natural treatments must be tempered with a word of caution. Beware of quick cure schemes and tonics! Books, websites, and TV commercials are used to prey upon those who suffer from chronic diseases. Run a simple internet search for RA and you’ll find all sorts of claims like, “New breakthrough for arthritis discovered!”, “I was cured of arthritis. You can be too!”, and “Diet can send you into remission.” I apologize in advance for any reader who was hoping to find a miracle, natural treatment for RA in this post because it just doesn’t exist. This quote sums up my view on natural therapies… 

Alternative therapies are popular among people with rheumatoid arthritis, however, they should complement, not replace, conventional care.[vi] 

I offer the following words of advice based on the Weapons series: 

1. There is currently no known cure for RA and anyone who tells you otherwise is wrong.
2. Take your prescribed medicines. Particularly those that have a long term impact on RA-induced inflammation like methotrexate and biologicals.
3. Be willing to try various medicines to see what works. When one doesn’t work or stops working, try something else.
4. Eat a healthy, balanced diet.
5. Speak with your doctor about any supplement you take.
6. Live life with moderation.
7. Use any safe method for short term relief of pain.
8. Don’t fall for schemes that prey on the chronically ill who are desperate for a cure.
9. Hold onto to hope as new anti-inflammatory treatments are always in the pipeline.
   

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[i] http://www.webmd.com/diet/guide/anti-inflammatory-diet-road-to-good-health 

[ii] http://livingwithra.wordpress.com/2009/07/19/the-trio-of-triggers-of-autoimmune-diseases/ 

[iii] http://www.mayoclinic.com/health/rheumatoid-arthritis/AN00198 

[iv] http://www.webmd.com/rheumatoid-arthritis/guide/rheumatoid-arthritis-natural-treatments 

[v]http://www.umm.edu/patiented/articles/what_lifestyle_changes_can_help_manage_rheumatoid_arthritis_000048_10.htm 

[vi] http://altmedicine.about.com/od/arthritis/a/rheumatoid.htm

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