Rheumatoid Arthritis

Dr. Dean Edell: For nearly 2 million Americans, rheumatoid arthritis is a fact of life. It most often strikes women between the ages of 20 and 50 with crippling results, but new drugs are battling RA from a different angle, not only providing relief but the hope of remission. Lori Pucci Ray: From the top of my neck to every toe in my foot, hot, pink, nasty feeling joints. It was kind of like being a tinman. Dr. Dean Edell: These sound like words of an 80-year-old. Lori Pucci Ray: I was 29 and 30. I had been ill for about 11 months. Dr. Dean Edell: But, Lori Pucci Ray is a young woman describing symptoms of a disease that made her feel old before her time. Lori Pucci Ray: I was at the point where I thought I really was never going to get better. Dr. Dean Edell: Lori was weighed down by RA or rheumatoid arthritis. Dr. Mark Genovese: Rheumatoid arthritis is a process where the immune system for unclear reasons goes awry. Dr. Dean Edell: It starts with swelling of the joint lining and as it progresses, that lining thickens, inflamed cells release enzymes that can destroy bone and cartilage. Lori Pucci Ray: They didn't have medicines when I was young like they do now. Dr. Dean Edell: Until a few years ago, doctors may have only prescribed over-the-counter pain relievers or drugs like Prednisone. Later drugs, called Disease-modifying antirheumatic drugs or DMARDs provided greater relief. Dr. Mark Genovese: Most commonly used is Methotrexate. Dr. Dean Edell: Then along came a class of biologic drugs called TNF inhibitors. Drugs like infliximab and etanercept not only relieve symptoms but can provide longer periods of remission. Dr. Mark Genovese: In general, we have seen a change in treatment strategies in the last decade, we are looking more aggressive use of existing medications, combinations of therapies. Dr. Dean Edell: TNF inhibitors block specific hormones that aggravate the condition, and are sometimes given with other drugs like methotrexate to stop further joint damage and pain. Francis Johnson: In my senior year in college, I was a cheerleader and the homecoming game, I woke up that morning and I had a really sore painful wrist. Dr. Dean Edell: Francis Johnson describes what happened to her 40 years ago just like it was yesterday. Francis Johnson: I fell and I started getting pains here and here, here and here, and other places and you have to realize that in the 1950s, the doctors did know about what we call juvenile arthritis. Dr. Dean Edell: Over the years, Francis tried treatment after treatment. Two years ago, she began using a TNF inhibitor, and it's struck the right note. Francis Johnson: I'm very thankful that I haven't had any serious pain very much at all since taking that. Dr. Dean Edell: Depending on the medication, some can be administered at home. Others must be given in a clinical setting. Francis Johnson: I only wish they'd had this drug, when I was like 20, and then I probably wouldn't be in this condition today. Dr. Dean Edell: There is another option only for patients who have not been helped by other drugs. Abatacept has approved this year by the FDA. Dr. Mark Genovese: It is a protein. It's designed to specifically inhibit one of the signals that's used to communicate within the immune system. Lori Pucci Ray: It's almost made my hands really normal. Now I can make a fist. Dr. Dean Edell: Some patients call them wonder drugs but biologic agents increase the risk of infection, both minor and serious. So it's important to discuss options with your doctor. Lori Pucci Ray: I'm a success story. I absolutely feel like I'm. Dr. Dean Edell: Once upon a time, Lori's outlook was not as positive. Lori Pucci Ray: I couldn't even make a peanut butter sandwich without getting somebody else to open the jar. Dr. Dean Edell: Lori has a newfound inner and outer strength. Strength, she says came from making diet, part of her rheumatoid arthritis treatment. Dr. Harris H. Mcilwain: Including foods that lower inflammation as well as getting rid of foods that trigger off inflammation. Dr. Dean Edell: Dr. Harris Mcilwain says some foods can reduce inflammation. Dr. Harris H. Mcilwain: Pineapple, dark grapes, dark cherries, blueberries, broccoli. Dr. Dean Edell: While other foods can trigger it. Dr. Harris H. Mcilwain: Like the sulfites or tomato sauce or wheat. Dr. Dean Edell: And diet alone can't do the trick. Dr. Harris H. Mcilwain: Controlling your body weight, very importantly, adding the exercises to strengthen the joints and make them more flexible, and then find the proper medications. Dr. Dean Edell: Physical activity can be a challenge for people in pain, but therapist find those who take the plunge feel a huge difference. Dr. Marian Minor: People with rheumatoid arthritis have less joint swelling, actual measurable joint swelling if they participate in aerobic exercise walking in water or bicycling. Dr. Dean Edell: Lori, Barbara, and Francis all make exercise and perseverance part of their routine. Francis Johnson: Whether it's work or play or sickness, attitude -- and no matter what it is, you just keep on plug-in along it. Dr. Dean Edell: Early diagnosis of RA and aggressive treatment can limit joint damage, loss of movement, and the potential need for surgery.