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Rheumatoid arthritis - a disease not to be taken lightly.

Those suffering from the advanced stages of rheumatoid arthritis know how debilitating it can be. In its earlier stages, however, it is often regarded as a benign disease and may thus be treated too conservatively, warn experts in the field.

Rheumatoid arthritis (as distinguished from the more common osteoarthritis, a normal accompaniment of the aging process) does not simply involve joints. It is now recognized as a systemic disease that can involve lungs, heart, blood vessels, eyes, spleen, and nerves. Recent studies have shown that serious rheumatoid arthritis is as apt to result in death over a 10-year period as is three-vessel coronary artery disease and late-stage Hodgkin's disease.

Because serious rheumatoid arthritis is not reversible and can progress rapidly, experts are now advising accurate, early diagnosis and more aggressive treatment. Patients should be counseled on nonmedical treatment, including properly balanced rest and exercise. In addition, treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) should begin immediately after the diagnosis is established. If the patient does not respond within 8-12 weeks, more specific medication should be employed.

These more specific disease-modifying medications include such agents as Plaquenil, Azulfidine, and gold. Because such agents have potentially serious side effects, the family physician should prescribe them in consultation with an arthritis specialist. If these medications do not produce results in a few months, stronger drugs with greater potential toxicity must be used. One of these is methotrexate, an immunosuppressive agent, whose fewer side effects have made it the favored drug of many arthritis specialists. When used with Plaquenil, it seems to have a "synergistic effect," in which each drug enhances the effectiveness of the other drug, with lowered overall toxicity.

Minor side effects of methotrexate include mouth ulcers and nausea. Major complications are liver toxicity, bone-marrow depression, and (rarely) severe lung disease. Patients on this drug thus need to be carefully monitored with laboratory tests and regular office visits. It should not be used by patients with liver disease or by pregnant women, and the accompanying use of alcohol and cigarettes should be avoided.

Properly selected NSAIDs act quickly to arrest pain and swelling, but the slower-acting drugs like Plaquenil, etc., can delay the disease. Prednisone, a potent steroid, will often reduce serious symptoms, but experts advise its use only along with other drugs and for brief periods of time.

The key to treating rheumatoid arthritis is thus early diagnosis and more aggressive treatment than that which is often employed. Only then are the serious, more far-reaching and potentially life-threatening complications of the disease likely to be avoided.
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Publication:Medical Update
Date:Dec 1, 1992
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