Dr. Norman B. Gaylis

This is an article that I have written many times in my life. It appears that when I look back and see what my articles reflected on the management of Rheumatoid arthritis initially twenty years ago and then more recently ten years ago. It is amazing that there was almost no change in my articles for both of those time periods. Now however, it is essentially an entirely new article.

This is because in the last years the treatment for Rheumatoid arthritis has undergone a major breakthrough. The new therapeutic discoveries have resulted in tremendous improvement for the patients suffering from Rheumatoid arthritis. The prevention of the disability and the joint damage that almost always occurred in these patients was unrealisticup until very recently. From my perspective the new treatments make it a lot more satisfying and gratifying to treat my patients with. Rheumatoid arthritis.

Rheumatoid arthritis is the second most common type of arthritis after osteoarthritis. It can affect the entire body, not only the joints. In fact it should probably be called rheumatoid disease rather than Rheumatoid arthritis. It has the potential to cause serious damage to any joint in the body and it can affect any age group. I have seen 3-month-old babies and elderly people as old as 95 years suffer from the disease.

The most, common complaint is simply pain, swelling and stiffness in the joints often with chronic fatigue. In the beginning, patients may feel that this is just simply due to over utilizing a joint. Once the condition sets in, it tends to involve more joints, be more persistent and cause more disability. This is because of the inability to perform ones basic needs at a fundamental level.

Rheumatoid arthritis is in fact, a disease of the immune system. Ironically, while the, immune system normally protects us against outside foreign bodies such as bacteria and viruses, in Rheumatoid arthritis, as in other autoimmune diseases, the immune system becomes confused. It is unable to recognize the difference between these foreign invaders and one’s own natural normal cells, and as a result, the immune system starts to attack our own natural tissues hence, the definition autoimmune disease.

Up until very recently, efforts to treat rheumatoid arthritis were at a lower level in the immune system. We obviously try to treat the pain and swelling of the joints with anti-inflammatories, corticosteroids, joint injections, which utilize cortisone-like medications, and moderate immune modulators which work to a certain extent to stop the symptoms of the disease. Medications such as methotrexate, gold and others like them certainly helped stop the symptoms of the disease but over the course of time, did not prevent progressive

damage and deformity that the disease caused.

The exciting breakthroughs, that I referred to in my first paragraph occurred approximately three years ago with the introduction of a medication known as Enbrel. Shortly thereafter, Remicade was approved for Rheumatoid arthritis and more recently a third drug, Anakinra has been introduced.

All three of these drugs, in different ways, work to not only suppress the immune system that is responsible for the pain and inflammation in rheumatoid arthritis, but also to prevent the joint damage that partially had been accepted as a normal process of the diseases progression. Studies are now showing that using these drugs not only prevent further deterioration of the joint, but in fact, reverse damage that has already occurred. From my perspective, the results of using this drugs on my patients have been dramatic. The benefit that has been provided in these patients who have previously been disabled and are now able to get out and work, play sports and perform activities that they had been unable to do for so many years is incredible.

As with any new medication, one needs to be cautious that. there are possible. side effects that we have not yet seen that we will see after long-term use. However, in the short term it would appear that the results are very dramatic. I believe any patient/individual with rheumatoid arthritis can look to the horizon with a lot more hope than ever before. Also, it is important that they be treated as soon as possible and the insurance companies should pay for these medications as soon as possible. If anybody has rheumatoid arthritis ‘and would like more information, or has rheumatoid arthritis and is not being treated with one of these new medications, I believe they should speak to their rheumatologist. They can certainly call my office to find out how to obtain one of these treatments, and if it is indeed appropriate for them or a loved one.