Monthly Archives: September 2009

Rheumatoid Arthritis (RA): Which Treatment Option is Best?

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Over the past several months I have received comments that I think need to be addressed in a much longer format than a comment response.  The comments are related to treatment options for rheumatoid arthritis and which treatment is best.

We are fortunate enough to have many options available to us today to manage our rheumatoid arthritis (RA).   Traditional medicine offers everything from NSAIDs (Non Steroidal Anti-Inflammatory Drug) like Advil and  DMARD s(Disease Modifying Antirheumatic Drugs) such as Plaquenil, Arava, Methotrexate, Gold, and Cyclosporine to biologics like Remicade, Enbrel and Humira. There is a growing trend toward alternative medicine as a  solution to  deal with this disease.  Each option has its benefits, risks and side effects.

NSAIDs are a class of drug that are used primarily to treat inflammation and mild to moderate pain.  These medications vary in potency and  include the brand names Advil, Motrin, Naproxen, Anaprox and Celebrex.  Between 10% to 50% of patients are unable to tolerate NSAIDs because of their side effects. These side effects include upset stomach, stomach pain, and diarrhea.  About 15% of people on long term NSAID treatment develop ulcers of the stomach and/or the duodenum.

DMARDs cover a variety of different of drugs.  Anti-malarial drugs such as Plaquenil (Hydroxycloroquine) are considered a DMARD and were initially used to treat malaria. It was discovered to help  arthritis when patients noticed an improvement in their arthritis symptoms while taking plaquenil for malaria.  Plaquenil effects the immune system but doctors do not know how it works for rheumatoid arthritis. Arava (leflunomide) interferes with genes in developing immune cells. When taking Arava, liver monitoring for toxicity is required.  You should not take this drug if you are planning to get pregnant or are currently pregnant because of birth defects. The most common side effects for patients taking Arava are rash, nausea, hair loss, liver enzyme elevation and anemia. Methotrexate is a chemotherapy drug that initially was used to treat acute leukemia.  Methotrexate (MTX) has become the gold standard for treatment of rheumatoid arthritis (RA).  Methotrexate interferes with the growth of cells in the bone marrow.  The most common side effects from methotrexate include stomach upset, hair loss, diarrhea, and  mouth sores.  Folic acid is given while taking this medication to reduce the side effects.  Liver function monitoring is necessary to watch for toxicity. Methotrexate should also not be taken if you are pregnant or planning to get pregnant. Injectable Gold has been shown to improve symptoms of rheumatoid arthritis however toxicity is common and constant monitoring in necessary.  Side effects include rash, diarrhea, conjunctivitis and marrow suppression. Cyclosporine is a medication that is used primarily for the prevention of rejection of transplanted organs.  It is effective for the treatment of rheumatoid arthritis because it stops an overactive immune system from attacking the joints. Side effects can be severe and include hypertension, kidney problems, headache, nausea and diarrhea.

Biologic response modifiers (biologics) are the latest treatment option for rheumatoid arthritis pain and inflammation.  They work by blocking the tumor necrosis factors(TNF) components of the immune system.  People with RA have too much TNF in their bodies and it overwhelms the immune systems response to inflammation. Biologics such as Enbrel, Remicade and Humira are genetically engineered proteins that binds to and deactivates the TNF molecules before they can do damage.  The risks in taking this class of drug include serious infection including sepsis and tuberculosis, nervous system diseases such as multiple scholosis, allergic reactions, lymphoma and congestive heart failure.  Because these drugs are fairly new their long term side effects are not known.

There has been much debate on the effectiveness of complimentary and alternative treatments options for rheumatoid arthritis.  These treatments include GLA (Gamma Linolenic Acid), DHA (Docosahexaenoic Acid, Tai Chi, herbal supplements and acupuncture. There are many more complimentary and alternative treatment options that will be discussed in future posts.

GLA (Gamma-linolenic Acid) is an essential fatty acid found primarily in plant oils. It is found in borage  oil and black currant seed. In preliminary testing it has shown to reduce morning stiffness and swelling however studies have been small to date and additional research would provide more information. DHA (Docosahexaenoic Acid) is an omega 3 fatty acid found in cold water fish. Several studies have shown that DHA reduces inflammation but not the progression of the disease. The movements of Tai Chi improve strength, flexibility and balance. There is no indication that Tai Chi effects the progression of rheumatoid arthritis. Acupuncture in thought to stimulate the release of chemicals called endorphins that block pain. Acupuncture is very effective in treating chronic pain like that in rheumatoid arthritis. The list of supplements as an alternative solution to conventional medicine for the treatment of rheumatoid arthritis include vitamin E, MSM, copper, manganese, vitamin C, selenium, zinc, bromelain, ginger, turmeric and boswellia.  These alternatives have proven to help in inflammation and in some cases joint damage.

The benefits of using conventional medicine for the treatment of rheumatoid arthritis are that knowledgeable doctors using this method are readily available and the medications work for many people. These medications have significantly improved the lives of many with rheumatoid arthritis. The downside to this treatment option is the side effects can vary from mild to severe and some long term effects are not even known.

The benefits to choosing an alternative medical solution for the treatment of rheumatoid arthritis is that the side effects to these treatment are few and are less damaging to the body.  The disadvantage to complimentary and alternative treatments are that finding a qualified medical professional that can help guide you through all the options available can be a challenge and there is debate on whether or not they can help with joint damage.

Ultimately the choice for a treatment option is a personal one.  What matters is what works for you. Everyone has their own body chemistry.  What works for one person may not work for another. The advantage that we have today is that we have options, many options, and if something is not working for us we can try in another direction until we find our own solution. It is not up to me or anyone else to decide what is best for you and your body.  Trust yourself to figure out what is best for you.

Find of the Month: 3M Scotch Cutter for Rheumatoid Arthritis (RA)

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Lately my hands have been giving me the most trouble.  The simplest tasks can seem almost impossible.  Using scissors to cut paper just to wrap a gift, or cut out coupons from the paper is increasingly painful.  I came across this little device the other day, the 3M Scotch Cutter,  and it has really made my life so much easier.

In looking into the product I discovered that 3M Scotch has a whole line of cutters for different uses.  I can only comment on the one that I purchased which is the paper cutter.  This little devise makes cutting paper a breeze.  With very little effort the cutter glides along the paper to make a nice neat even cut.  You can even go around corners with this little beauty.

If I could improve on one thing it would be the size of the handle.  Because griping things is a challenge right now I would have preferred something with a larger handle. Aside from that one issue I would highly recommend this product if cutting paper is giving you trouble.

I paid $6.99 for mine and it is worth every penny not to be in pain to handle this simple task.  I happened to find on the 3M Scotch site that they are offering a coupon for this product as well (here is the link). The coupon does expire on 9/30/09.

Run for the Roses for Arthritis Research Grants

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Sunday October 11, 2009 marks the annual Iota Sigma Chapter of Alpha Omicron Pi Run for the Roses 5K and 10K road races to benefit arthritis research. The perennial event in Ames, Iowa is open to all ages and running ability.  All proceeds from this race go directly to arthritis research grants.

Alpha Omicron Pi Sorority is an international women’s fraternity with 187 collegiate chapters and 320 alumnae chapters in the United States and Canada. Since 1967 the Alpha Omicron Pi Sorority has been supporting arthritis research. To date the Alpha Omicron Pi Sorority has donated over $1,500,000.00 in grants for arthritis research.

Through the  sponsorship of area businesses  for this run, the sorority has annually raised funds for arthritis research. This year the Run for the Roses road race will be held on October 11, 2009 and my twitter friend Mike Brekke will once again be one of the participants.  It was through Mike that I heard of this amazing group of women that have been supporting arthritis research for over 40 years.

I would like to thank all the participants, sponsors and most of all the Alpha Omicron Pi Sorority sisters for all their hardwork and dedication to a cause that may one day help me and the millions of others that are effected by this painful disease.  I am truely grateful for all that you have done.

Power of Pomegranates for Rheumatoid Arthritis (RA)

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One of my favorite healthy snacks this time of year is the pomegranate.  The kids and I just love to pick at the little gems and eat the sweet, crunchy seeds just as nature made them.

Pomegranates are native to the mediterranean region and are a good source of vitamins A, C, E , folic acid and potassium. The name “pomegranate” in Latin is translated as seeded apple.  The polyphenols in pomegranate juice are antioxidants that can prevent and repair oxidative damage caused by free radicals.

In a recent study funded in part by the National Center for Complimentary and Alternative Medicine researchers from Case Western Reserve University studied the effect that the dietary supplement made from pomegranate extract called POMx had on an animal model of rheumatoid arthritis (RA) in mice.  The mice were treated before and after the arthritis was induced.  The mice that were treated with the POMx before the induced arthritis had significantly reduced incidence and severity of disease than the untreated mice.  In mice that were treated to exhibit arthritis symptoms before receiving the POMx, the effected joints showed less inflammation and less destruction of cartilage and bone that those that did not receive the POMx.Future studies will test the disease modifying effects of POMx on mice that have been treated to mimic the symptoms of RA.

Pomegranates are available in the market in the northern hemisphere from September to February.  In the southern hemisphere you can find them from March to May but the juice is available year round.

National Invisible Illness Awareness Week: September 14 – 20, 2009

Today at 9am pacific time is the kickoff for the annual National Invisible Illness Awareness Week. During this week, those of us with invisible illnesses are encouraged to share our experiences living with our illness in an effort to raise awareness and understanding.  During this week there will be online seminars via blog talk radio discussing the common bond of illness that is not clearly visible to those around us.  The topics of discussion include the emotional side of chronic illness, dealing with the stress, and how to pay for medical care.  Featured speakers include Rosalind Joffe, Jennifer Jaff and Jo Franz. If you are interested the National Invisible Illness Awareness Week site has a listing of the conference schedule on their site click here for the link.

Rheumatoid Arthritis (RA) and Choosing a Dog

There are many factors to consider when choosing a pet. Having rheumatoid arthritis (RA) weighs heavily in the decision making process.  As a animal lover and owner of many dogs over the years, temperment, breed and animal size are very important issues to consider before making a commitment that will last many years.

Max

Max

The first step in finding the right dog for you is research.  Go to the local library and read some books about the type of dog you may be interested in adopting. Research online; the American Kennel Club (AKC) and DogBreedInfo.com both have good sites with plenty of information to help you choose the dog that is right for you.  If you are interested in a shelter or rescue dog go to your local shelter and ask a lot of questions. Spend some time with the type of dog that you may be interested in before making the committment.

Daisy

Daisy

Some of the factor that you may want to consider are:

  • Size: I am speaking from experience here. I have a large golden retriever(Max) and a small silky terrier (Daisy). They are both good dogs and very loveable, but Max can’t help his size and when he gets excited he has been known to hurt me inadvertently.  I can’t count how many times his 80 pound self has stepped on my inflamed feet, or he has come bounding by and run right into a sore ankle. My golden retriever is loyal and kind but he can’t help his size and that is a factor with my rheumatoid arthritis (RA).  The little silky terrier is easier when negotiating small spaces and even though she has also stepped on my sore feet she is so small it didn’t hurt at all.
  • Space: How much space does your potential pet need and how much space are you able to provide for it is another important factor.  Max takes up a lot of space and he frequently wants to be near me.  This means that on many occasions just trying to navigate around him can be a challenge. When I am flaring every extra step I have to take can be painful and the extra ones need to avoid the sleeping giant can be hard.
  • Energy: Some dogs have boundless energy, others like to lay at your feet.  My silky terrier Daisy is a bundle of energy.  She runs all day long, she always has something to investigate.  At the end of the day she rests (usually just collapses from exhaustion).  It is important to factor in that this type of dog needs a lot of exercise and that may mean walking this dog plenty.  (As a side note, we have an ample yard and an invisible fence so that my dogs can run at will and walking them is a luxury when I am up to it.)
  • Cost: Dog ownership is an added financial burden that you need to consider.  Veterinary costs can be expensive and regular feeding and mantenance costs can add up.
  • Puppy vs. Dog: Puppies are cute and cuddly but they are baby dogs and require much more attention that full grown dogs.  The benefit to a puppy is that they haven’t learned any bad habits yet, but house training them can be a challenge when you have rheumatoid arthritis (RA) because a quick dash to get the puppy out may not be an option if you are in the middle of a flare.

Dog ownership has many important benefits. Dogs can lift your mood, decrease your blood pressure and reduce stress.  They are always happy to see you and give unconditional love.  They can be trained to be a great help as well although mine are just really good at giving love.

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