Rheumatoid Arthritis

Does anyone have a problem with severe numbness & tingling of hand &
arms at night? I wake up about every hour because my arms & hands have
fallen asleep. It takes quite a while for the feeling to come back &
is very painful as the feeling returns. Has anyone experienced this?

I have been using Humira for approximately 2 years with no problems (other than
the
intense burning sensation upon injection). I inject it into my thighs, once
every 2 weeks.
Before that I was on Remecade for about 3 years. I've been told that both drugs
are
essentially the same.
My problem, at this point, is paying for the Humira. I used to get it free,
but now
something is going on with Medicare, and it seems that I will have to pay an
out-of-pocket
deductible of about $6000./year. Frustrating!! (I'm not sure I'll be able to
continue it.)
I sure hope Humira works well for you.
Cindy

Saw this on another list. It's from the Schleroderma Foundation.
Nina
A new website has been launched that is dedicated to improving the quality
of medical care in the United States. The site, www.DrScore.com, provides
patients with the opportunity to give feedback to their doctors and find new
doctors-all for free.
DrScore.com lets patients rate their satisfaction with doctors in such areas
as patient interaction, office staff, and office facilities, says Dr. Steven
R. Feldman, the founder of DrScore. Dr. Feldman is a professor of
dermatology at the Wake Forest University School of Medicine and a member of
the National Psoriasis Foundation Medical Board.
"We believe in the quality of care that American physicians offer and in
their commitment to provide the best care in the world," Feldman said.
"DrScore empowers patients to enhance the quality of their care by sharing
feedback with their physician. At the same time, it empowers physicians to
improve the care they offer by giving them information that they otherwise
can get only by going to the expense of setting up their own patient
satisfaction surveys or hiring a consultant to do it for them."
DrScore does this with a unique, web-based, adaptive patient-satisfaction
survey that patients fill out online. The website protects patients'
anonymity by collecting no personal or demographic information. However, the
website allows patients to rate their doctor only once every quarter, to
prevent the results from being skewed. Patients can view summary ratings of
physicians for free, as can doctors. For a nominal fee, doctors can receive
more detailed ratings about their practice.
DrScore also believes in the importance and value of patient advocacy
groups, such as the Scleroderma Foundation. "When a person searches for a
doctor, the site automatically pulls up links to relevant advocacy groups
and other patient resources, based on the type of doctor the person
researches," Feldman said. The site also has links to "featured patient
resources"-which change periodically-on the home page. The Scleroderma
Foundation will be featured on the home page during the next couple of
months in honor of Scleroderma Awareness Month in June.
The website's interest in working with advocacy groups springs from
Feldman's involvement as a member of the medical board of the National
Psoriasis Foundation. Nicola Ries Taggart, the former director of member
services and community relations for the Psoriasis Foundation, is DrScore's
director of advocacy relations. DrScore recognizes that joining patient
advocacy groups is one of the best ways patients can improve their care.
Taggart has been working with advocacy groups to make sure DrScore is
promoting them well and to encourage advocacy group members to try the site.
"DrScore suits patients' increasing use of the Internet to seek information
about their health, and healthcare providers, by giving patients a
systematic way of assessing physician quality," Feldman said. At the same
time, DrScore gives physicians a standard benchmark that they can use to
document the quality of care they provide.
"DrScore works to the benefit of both patients and their doctors," Feldman
said. "We see ourselves as a partner and a catalyst in helping enhance the
quality of medical care in the United States."
Media Advisory: For background on DrScore, go to www.DrScore.com and follow
the link to the Media Room, or contact Frank Elliot at pr@....

Inactive Ingredient Database (updated)
http://www.accessdata.fda.gov/scripts/cder/iig/index.cfm

I'm going to the rheumatoid doc next Monday. My primary care doc has
said I have RA. My RA levels are slightly elevated, my CRP elevated,
but no high sed rate. CRP has fluctuated (is that typical as the
inflammation flares up and subsides?) I have been having infrequent
flare ups for almost two years, but didn't really think it could be RA
until a year ago. My concerns are how aggressive should I treat this?
I have a background of having hepatitis C. I did the chemotherapy like
treatment with interferon injections 3x a week plus antiviral pills for
6 months. I often wonder if the RA is a side effect of these toxic
drugs and wonder if I should do the DMARDS (if that's what the doctor
recommends). I'd like to pick your brains and see what you all think.
I have found through my hep c experience that the educated patients are
often more informative than the doctors.
Thanks for your input,
Cindy

hi there,
I have just seen my Rheumatologist and i am being taken off Remicade
and put onto Humira - as the Remicade (which i have been on for 12
months) is not working. I am also on Methotrexate, Prednisolone,
Celebrex and Clinoril.
I am nervous about the Humira. I would love to hear of your
experiences with this drug.
Thanks
Suzie

I went to the rheumy today, he put me on more meds I think he said
something had sulfer in it, I could be wrong. (I'll write back with the
names of the meds I cant read the script LOL). He DID say that it IS
RA, but a mild form and that he will try to 'keep it that way'. Not
much was said beyond that.
I asked if he's sure its not Fybro since thats what I've been told for
2+ years. He said no, my RF was high and other factors make it RA. I
was like yeh and...? Hoping for more explanation as to whey i did not
have the correct diagnosis from other dr.s but who knows... it feels
good just to be confirmed.. you can only move forward from there right?

Nina has sent you a story: "nbc5i.com - HealthWatch - Expert: Christopher
Columbus May Have Had Arthritis"
the link:
http://www.nbc5i.com/health/4465787/detail.html

Hi All,
I am a health student carrying out a thesis on RA and hoping to use
this information to add to the literature and treatment available to
people with RA. I have finally come to a conclusion on the
measurements I am going to be using in my study, one being related
to beliefs and attitudes, one being related to coping styles, and
one being related to arthritis impact. However, I was wondering if
anyone here would be willing to complete these questionnaires and to
also give me some feedback on them. If I can see some completed
then it would give a good idea of whether they are gaining the
information I need for my thesis. The first two questionnaires are
very quick and will take a couple of minutes, whereas the impact
questionnaire has been said to take about 20 minutes. Therefore, I
totally understand if you would rather not take part or just don't
have the time. If you do have the time or desire to have a go at
the questionnaires then please contact me at nicnac234@....
I would really appreciate your help
Best Wishes,
Nicola
P.S. All questionnaires will remain completely confidential and
will not be used without permission. This is merely as a way of
testing the validity of my proposed measurement scales.

Nina has sent you a story: "nbc5i.com - HealthWatch - Laser Technique Can Help
Soothe Pain"
the link:
http://www.nbc5i.com/health/4440964/detail.html

Nina has sent you a story: "nbc5i.com - HealthWatch - Therapy Jumpstarts Natural
Pain Relief "
the link:
http://www.nbc5i.com/health/4455221/detail.html

This is about the arthritic foot. Paula I thought you would be
especially interested.
It is from a lecture I found online that actually covers just about
the whole RA bundle. The site is a podiatry site. Hence the
concentration on feet. Here is the site - it's not a real optimistic
statement of the facts but it sounds fairly accurate to me. At the
end there is a paragraph about management of RA
http://www.latrobe.edu.au/podiatry/rheumatology/rheumatology_lecture_2.htm
Annette
Early involvement of the foot
many cases start with symmetric involvement of metatarsophalangeal
joints presents as "metatarsalgia" - often also metacarpophalangeal
joints.
more likely to be lateral MPJ's in early stage can be tender to
palpation - seen as MPJ oedema on dorsum and widening of forefoot
may be painful on compression
plantar or interdigital bursitis and/or flexor tendonitis may be
initial presenting complaint can be detected by ultrasound, often
before being symptomatic.This may present as 'spreading' of the toes.
Three case reports on spreading of the toes as presenting feature of
rheumatoid arthritis
rearfoot and ankle can also be an initial presentation of disease process
radiologically juxta articular demineralisation in affected
joint; rarely get joint space enlargement at this stage; cysts, bony
erosions are prime feature occur at margin not covered by articular
cartilage usually on medial side of joint, except in fifth MPJ in
which lateral side is affected early
radiographic changes in the foot early in rheumatoid arthritis is
indicative of a more aggressive form of the disease
Late Involvement of the foot
progressive foot deformities are invariably seen in all those with
rheumatoid arthritis at later stages
generally most have either a predominant involvement of forefoot or rearfoot
pre-existing biomechanical/pathomechanical foot disorders will
exacerbate foot symptoms
Forefoot:
lateral deviation of toes, clawing of toes, subluxation of MPJ's.
MPJ deformities occur in almost all cases within 10 years --
foot function. Digital lesions develop from increased pressure
hallux valgus (may have pre-existed ? made worse by rheumatoid
arthritis). Incidence increases with increased duration of disease.
anterior displacement of plantar fat pad --
plantar lesions and pain
spread of forefoot (splaying) & plantar depression of metatarsal heads.
plantar hyperkeratosis and bursitis
forefoot supinatus
Mid/rearfoot:
midfoot involvement --
occur early with minimal symptomatic joint involvement may be reason
for higher incidence of plantar fasciitis in rheumatoid arthritis
rearfoot pain common (but less common than forefoot involvement)
pain from involvement of joint or achilles tendonitis or
retrocalcaneal bursitis (may get erosions on x-ray from bursitis)
subtalar involvement --
ankylosis of tarsal bones may occur late in the disease
valgus rearfoot (can be very disabling) initially flexible, then
limited range of motion at subtalar joint --
ankylosis. The rearfoot going into valgus is most likely due to the
disease process in the joint, a weakness and laxity in supporting
structures and an inability of the foot to counter the normal early
stance phase pronation.
impingement of the calcaneo-fibular ligament has been suggested as
the cause of lateral pain in the rearfoot
tendon sheaths around rearfoot may become affected
posterior tibial dysfunction. Tears of the posterior tibial tendon
are common in those with 'flat feet'.
radiographically talocalcaneal sclerosis; loss of joint space,
osteophytes, angular changes associated with flat/pronated foot,
erosions uncommon in midfoot & rearfoot
Other foot involvement:
plantar heel pain in 2-3% - calcaneal spurs more common. Fibrosis
of the plantar heel fat pad has been demonstrated
changes in composition of fatty acids of heel pad have been shown ?
increased fat viscosity --
tarsal tunnel syndrome can occur at any stage sometimes it occurs
in initial stages
subcutaneous nodules most commonly plantar to central 3 metatarsal heads
tenosynovitis of long flexors and extensors
bursitis --
atrophy of subcutaneous tissues (as part of disease process or
secondary to corticosteroid use)
longitudinal nail beading late in disease (may be due to vasculitis
of nail bed)
vasculitis --
stress fractures (due to osteoporosis)
gait changes --
of stance (due to avoidance of pain and muscle changes). Knees and
hips tend to be flexed.
ankle oedema (may be due to hypoalbuminaemia or lymphatic blockage
from knee joint effusions)
venous insufficiency
mild sensory neuropathy
wound healing difficulty (vasculitis affects wound oxygenation;
patient may be on corticosteroids or immunosuppressives)
leg and foot ulcers (most due to venous insufficiency and vasculitis)
side effects of corticosteroids --
(may predispose to calcaneal stress fractures)
Radiographic changes in foot
Bilateral and symmetrical distribution of changes; periarticular
osteoporosis (early) and generalised osteoporosis (late); uniform
joint space narrowing; synovial cyst formation; central and marginal
erosions; bony ankylosis; deformity; soft tissue swelling
Management of RA
Patient education and motivation (information on disease, treatment
and prognosis include spouses/caregivers) many lay publications
and organisations can help
Exercise (especially range of motion exercises and aerobic fitness)
complete rest may be needed in acute phases
Physiotherapy (patient education, swelling reduction, heat, cold,
exercise, joint mobility, electrotherapeutic modalities)
Joint protection splinting and braces (especially during active phase)
Occupational therapy eg using alternative ways of performing tasks
to reduce strain on joints; household and personal aids
Good nutrition especially for weight reduction if indicated and
increased intake of omega-3 fatty acids has been suggested to be of
benefit
Complementary/alternative therapies used by up to 80% of those
with rheumatoid arthritis
Surgical (eg fusion for cervical subluxation

Hello, everyone...
I was diagnosed with RA several years ago, in particular, a form that
manifests itself in a rare, painful type of glaumcoma that affects one eye. The
glaucoma has been the worst symptom of RA for me until recently.
I've always had joint pain that was particularly bad in the morning, but I
dealt with it via nuprin and other OTC NSAIDs. The pain in the last few months
has gotten a lot worse. I went back to the RA dr. who prescribed celebrex again
(I had a bad experience w/celebrex the first time he prescribed it; his
solution was to double the dose...!)
The RA dr. said to call him if the celebrex doesn't work, and he'll prescribe
"something else." I'm a little on the paranoid side about strokes (a
possibility w/celebrex), so can anyone who has been in this position tell me
what the
next step might be when celebrex doesn't work?
The other question I have is one I experienced with the opthamologist who is
treating my glaucoma. As I said, it can be extremely painful (like someone
drove a spike through your temple.) I see this dr. a lot to monitor my eye
pressure. One day, I asked him if he could prescribe a pain reliever. I got this
big
lecture about how the pain would go away once the pressure was reduced; well,
I've been going to him for over a year, trying every type of drop and pill
possible to reduce the pressure, and still the pain comes back. I guess I was
just in a really bad mood, the way you get when you're in pain, and I said, "So
what's your solution? That meanwhile, while you play around with drugs and
drops, I should suffer? When you could do something to stop this pain, you
don't?
What kind of doctor are you? Do you get off on watching people in pain?"
I got a prescription for tramadol. Unfortunately, or maybe because of all the
other freaking drugs he has me on, I broke out in a rash when I took it, so I
had to discontinue it after one pill.
The appointment with the RA dr. was a few days after this. I asked him what
he does for pain relief. He told me to take Tylenol. I said, you went to
medical school for that? He said he does not prescribe pain medications for RA
patients, no matter how bad it is. He said you can learn to live with pain. I
said,
and why should you? He hissed, you could become ADDICTED! I said, and that's
bad for what reason again? If the medicine relieves pain and gives you a life
again, isn't there a way to manage taking it?
I swear he broke out in a cold sweat.
I had also mentioned to this dr. that the pain in my joints made sleeping
difficult if not impossible. He slyly said, well, you know, there are sleeping
pills.... I said, I don't want sleeping pills. I could sleep if this didn't
hurt. He laughed and said, so there are some drugs you don't want!
I could've slapped him.
Maybe I'm just pissed off about being in pain so much, but I've been trying
to do research about why pain killers are so bad, and the reasons I get are
just BS. I wonder how many people are SUFFERING needlessly because drs. are
afraid to write prescriptions for painkillers. And I wonder why there's some
kind
of onus put on people in pain, as if they had weak characters or something, for
wanting relief from pain.
I know many of you are in much worse shape than I re: RA, but I'm also sure
you've been through the pain killer route. I guess I'm angry at the RA dr's
snide attitude (i.e., he blew off my concerns about the stroke implications of
celebrex, and seemed to think I was some kind of drug addict for having the
nerve to even ask about pain relievers.)
I do need to know what the next step up is from celebrex when celebrex
doesn't work. But I'd also like to hear some opinions about pain relief and pain
management.
TIA for any help.
Debby

Ah Yes, Yet ANother Painful DAy.
I take 140mg methadone and 8mg of dilaudid for pain but I am about to
loose my mind. This pain not only from RA but Fibro and
Myofascial.Just wanted to share my misery..Skye

well i am on enbrel and i dont have medication coverage i didnt know how i was going to pay for it next month. i went onto enbrel.com last month and saw they have a program you need to apply for and there are no promises that you will be accepted because there is limited space well i got this letter friday reading the following.......

i cried when i read it and i called my mom and of course she cried...

dear dawn malek,

congratulations and welcome to the medicare repalcement drug demonstration. we have had the opportunity to review and process your enrollment packet and have found that you are qualified for the program. you are eligible for the prescribed drug(s) etanercept (enbrel) under the folling benefit: benefit level 3. your coverage will be effective 5/15/2005.

it came with a chart and shows under benefit level 3 i must first pay an annual "deductible" of $0. after the annual deductible, i pay this amount for each prescription until my total allowable drug costs=$5,100. *a fixed copayment of $2 for generic or preferred multi-brand drugs or $5 for all other drugs.
once my total allowable drug costs reach $5,100 i pay nothing.

i am sooooooo excited. :) YAY! my mom said i totally made her mothers day this past weekend. :)

-dawn-

Hi Cindy,
This is Steph in VA. I'm 27 and was diagnosed with arthritis when I was 22 (5.5 years ago). It took 13 doctors 2.5 months to dx me. It felt like forever to me but I soon came to realize many people take years to get dx'ed.

I agree that blood tests don't mean everything. My current rheumy is great at understanding that. If I tell him I don't feel right he'll test my ESR and CRP. If they come back fairly normal, sometimes I'll make a face. Dr. Lawson is quick to remind me that normal bloodwork does not mean pain is all in my head.
The dry mouth might be a side of Sjrogen's Syndrome, which is usually a secondary illness (fibro could be your primary illness).

Don't worry about the memory thing. I'm 27 and sometimes I'll walk to my secretary's desk and forget what I was about to tell/ask her. I blame my "spazz moments" of my meds.

When my symptoms first appearred, I was sent for several x-rays (before my dx). They just show if you have breaks or severe erosion. Once I was dx'd I was sent for an MRI and a bone desnity scan, which showed the rheumy more.

About bad weather ... I have better predictions that the weatherman. This winter I had a 97% accuracy rate of predicting precipitation within 24-36 hours. My co-workers bet me the first time I suggested snow/rain and I was right.

Take care,
Steph in VA

Hi, I joined this group a few years ago when I got a blood test
saying I had a very high rheumatoid factor. Being naive to what that
meant I started doing research on R.A.
I'm 24 years old, my mom was diagnosed with lupus at 25 (right after
she had me). I was officially diagnosed with Fybromyalgia about 2
years ago if memory serves (which it usually doesnt j.k.)
Now I am seeing a very well known and highly recognzied
rheumatologist in my area (he has been treating my mom for 20 +
years). I have only had one visit with him thus far. WHile he was
doing the routine checks, my neck would crack when moved, my knees
would pop when bent etc. etc. He just said that I should not sound
like this at 24.
He kept asking me if I get dry mouth. I basically told him that
generally speaking I'm always thirsty. My younger sibling is the same
way. So I wouldnt think that dry mouth is something that would alarm
me or even be somethign I noticed on a daily basis.
He told me he thinks I have some form of R.A. that is not very
progressive (knock on wood). but we have not gotten the blood test
results back (go this tuesday the 10th). Now mind you, this is the
THIRD rheumatologist I've seen. The first two said I had
fybromyalgia. THis one said there is no way I have that.
I even had X-rays taken back in October 2004 and they said no signs
of rheumatoid artritis, though the areas they x-ray'd hurt like hell.
Sometimes my pain is centralized to one side of my body then
progressies from top to bottom or vice versa. Usually its in my
forearm, neck is really bad and shoulder area. my wrists and elbows
can get bad in cool weather especially.
I'm sorry to ramble... But I just wanted to get your educated input
on this whole thing. How many dr.s did you all see until you were
finally correctly diagnosed? Is that normal for doctors not to
diagnose right away? My rheumatoid factor seems to go up every year.
If I do have R.A., would that mean it is getting worse?
I will be sure to check back in after my results tuesday..
Thank you all and God Bless...
Cindy

Hi Skye...
I hope you're doing okay. Haven't heard from you and wondering how
you are.
I think I missed answering someone's question about my mouth
problems...(besides it being big..hee hee) I do have problem eating
because of Sjorgens..it's so dry. But alos, my lips are sensitive to
almost everything. Batter on fish..is too crispy for me.. any salad
dressing too spicy..any condiments are too spicy. All the food stuff
hurts. Pass the Gerbers....
Hugs..Paula

G'Day everyone,it has been awhile but I am feeling better. The
results of my CT scan were neg. but for a tiny little spot. Anyway
I wil be restarting my enbrel and mtx again today. We record this
weekend so everyone please pray my fingers do not get stiff.I have
been looking forward to this day for awhile ,to say the least.
I am so thankful that I am having a good morning.I hope most of you
are .I am realistic and know alt of you are feeling bad..I am sorry. I
get that way most of the time.Hoping the enbrel will work.
Speaking on fatigue,that is a problem for anyone who lives with
chronic pai.The pain wipes you out and so does the meds. Keep hangin
in.And A BIG THANK YOU for all the support you have given me...High in
th SKYE

Nina has sent you a story: "nbc5i.com - HealthWatch - Therapy Jumpstarts Natural
Pain Relief "
the link:
http://www.nbc5i.com/health/4455221/detail.html
Message from Nina: Interesting.

I think I have written in this forum before about possible foot surgery
to fuse my foot to my ankle to help decrease pain and increase
steadiness. I went to see my orthopedic surgeon who said that my foot
is trying to fuse on its own. So he put me in a removable cast for six
weeks with the hope that it will continue to fuse and we won't have to
do surgery. Wouldn't that be great? But it's heavy to drag around and
there's no getting around talking about it at work. So I came up with
some really good answers to people asking me what happened to my foot:
motorcycle accident. skydiving, bull-riding, and my favorite,
street-luge.
Having a sense of humor is definitely a must. It's only been one day,
but my foot is aching a lot. I think I'm going to get pretty grumpy
over the next six weeks. And it's a bright royal blue, so now I have to
coordinate my outfits to it!
gloria

Hello everyone!
Does anyone know of a website or information on the sed rate and c
reac test ranges? I think I got good ranges today, (much better than
the last couple of times anyway), but wanted to see what normal, high,
and low are.
I'm sorry that it seems as if I only am around when I need something,
I do keep up, just don't get to visit as often as I like. I can't
believe I thought becoming a stay at home mom, I'd have more time to
post..haha
Thanks,
DeeDee

Hi Deborah,
This is Steph in VA. I take Remicade (400 mg every 6 weeks) and methotrexate (20 mg every Saturday), among other things. To prevent an allergic reaction to Remicade, my rheumy has ordered Tylenol and Benadryl 30 minutes before infusion as pre-meds. I've been on Remicade for 5 years this month and I haven't had any problems, thankfully.
Take care,
Steph in VA

Evening all...
I have a question to post for everyone. I am really fatigued lately
to the point where I could sleep all day and not move. My arms and
legs feel like I ran a marathon...like my whole body has nothing left
to give. Has anyone else experienced this? Is there something I'm
missing nutrition wise or what?
~chris

Has anyone ever heard of or tried 'enzyme therapy' to treat their RA?
I am seeing a Dr in a few weeks to talk about it - apparently it is
believed to help with inflammation and pain....? (I am not coming off
any of my drugs to try it, it will be supplementary therapy only)
Suzie

When my RA flares in my wrists, hands, and elbows, my entire
arms hurt too. I feel like I have 2 broken arms, and I wonder why
if there are no joints in my arms that I have pain there?
Thanks,
Elizabeth

Hi All,
My RA is affecting my wrists, arms, etc. I love to read for
pleasure but holding a book is agony and I wondered if anyone
can recommend a product that allows me to read in bed without
holding the book?
Thanks so much!
Elizabeth

I am having a bad flare up today and in a lot of pain any ideas as to
how i can get it under cotrol with out calling the doctor it feels
like i call the doctors all the time do you think it would be alright
if i upped my predisone i am on 10mg a day aleady a day already the
weather has been cold and terable here l know that helped with my
flareup thanks for listening Sherrie in Oklahoma

Im going to get all mushy now. You all are beautiful. AARDA.org is a
good site,they have a quiz you can take 10 questions. It might put a
lump or two in your throut, no worse than squishy feelings like
missing Jenni's prom. I've heard seen one seen 'em all. My daughter
went with her brother. Neither wanted to go, so I ruined their lives.
How many have rolled out of bed onto the floor in the wee hrs and had
to holler for help getting back up? Falling naked is my worst fear.
Other than being a burden.SSI burden on the tax payers, burden on
kids,heck I can't even tend the critters any more. I want a dog sooo
bad but I can't care for one. I stalk pets and their owners at parks
and redlights. Did the cold weather brng a darkcloud of pessimision or
what? I love you loads

Paula, thank you fro that nice note, I went and read
the rainbow bride poem. I cried We found her on
our doorstep. We named her Pickles after my mom who
passed away a month before she loved Pickles and she
could not have them. Anyway she was spayed
and declawed.
She was a joy , funnier than heck.
She got sick last Sunday didnt eat or
drink and her
belly hurt so I took her to the vet on Monday.
He did all kinds of tests. Come to find she
had masses
in her chest and she was in acute renal failure, after the
test he said her one kidney was gone and she had
adhesions in her abdomen, she probably had
lymphoma
But she played like a nut on Saturday, I jsut
don't understand how she got so sick so quickly.
He told me she would only live for about 2 weeks if I
took her home on sub q fluids and antibiotics and she
would be ill, I didn't want to put her through that.
I didn't want to see her suffer. So I hope I did the
right thing. We miss her terribly. I have my mons
19 year old cat who sleeps all the time. Pickles would have been
6 this year. I will see if I can add a photo. Thanks for listening
to me..Sandy p.s do you have another email address
that I could send you her photo..have a good night

Hello everyone, recently I had to put my dear
cat of 6 years to sleep and this was awfully
stressful, this happened on Monday and now it
is Sunday and I am flaring with my RA awful.
Do you think this is a delayed reaction to the
stress of losing my per. I still am upset
I still cry everyday when I do things that we
used to do together. Sorry if you think I
am goofy just wondered if this has happened to
anyone out there..Thanks Sandy

Hello Sandy...
I'm so sorry that you had to put your kitty to sleep. I also have
cats..one is about 13, the others 5 and 4. I would hate losing any
of them. I also have a poodle that is 16 yrs old. He has arthritis
just like his mom.
It's very traumatic to lose your pet. We love them so much and
there are so many of us who have dealt with it or are going to
eventually. It's so hard to let them go. But I know your kitty is
at the Rainbows Bridge with the other pets.
We are not only here for support about your r/a but also support
emotionally. Talk about her if you want, share your story about
kitty. Getting help emotionally is just as important as getting meds
for our r/a.
Stress and a traumatic events can cause a flare. I know that the
drs were trying to decide if my r/a manifested itself because r/a
runs on my mom's side of the family or if it was helped along
because my mom passed when I was 32. Tough call...because that is
when I first noticed things not quite right.
Hang in there...cry cry cry and get it out.
I have a friend who's dogs have passed and she went to
www.rainbowsbridge.com and started a little memorial where you can
pick out the headstone for your kitty/doggy and leave flowers, give
them toys, etc. It just depends on what you'd like to do. I don't
think I would do that, but people deal with loss differently.
Talk if you need to..
Hugs..Paula Ohio

My RA is active in my elbows arms and wrist and I noticed that where the pain
is a I have developed an odd shaped red rash. I had been rubbing it but it
doesn't like like it is from rubbing it. I take Humira. Has anyone ever
experienced this or know what it is? Thanks Elizabeth

Here is some additional information on MabThera or Rituxan as it is called in this country. Since it is a biologic the route of administration would be injectable. I don't know if it would be IV as is Remicade or sub-Q as with Enbrel and Humira and it could be a couple of years before it is approved for RA but at least there is something new on the horizon.for the patient who is not responding to conventional DMARD therapy (i.e. Methotrexate, Enbrel, Humira and/or Remicade)..

I cut and pasted the following information from the Roche Pharmaceutical Company's website.

About MabThera
MabThera is a therapeutic antibody that binds to a particular protein - the CD20 antigen - on the surface of normal and malignant B-cells. It then recruits the body's natural defences to attack and kill the marked B-cells. Stem cells (B-cell progenitors) in bone marrow lack the CD20 antigen, allowing healthy B-cells to regenerate after treatment and return to normal levels within several months.

MabThera is indicated as a single-agent treatment for relapsed or refractory indolent NHL, and received European approval in March 2002 for the treatment of aggressive NHL in combination with CHOP chemotherapy. MabThera is known as Rituxan in the United States, Japan and Canada. More than 370,000 patients have been treated with MabThera worldwide to date.

Genentech and Biogen Idec co-market MabThera in the United States, and Roche markets MabThera in the rest of the world, except Japan, where MabThera is co-marketed by Chugai and Zenyaku Kogyo Co. Ltd.

Hello Paula ,

heres something i fould on this link about eye damage and courdasotads

john

Note: forwarded message attached.

This MedicineNet.com article has been sent to you from
marciastoyle@...
Message from sender:

Hi all...
I heard that cortisteroids can damage your vision. Is this true? A
friend of mine mentioned that her aunt was put on cortisteroids and
almost lost her vision.
Take care....Paula
Another rainy weekend in Ohio

Am trying to find out if my being diagnosed with Neuralgia has
anything to do with my Rheumatoid Arthritis or Lupus. Anyone knows,
please contact me. Thanks!

Hello to my favorite group.. I have no results today.I wasn't able to
go to the appt. We are having a family crisis so I had to postpone my
appt. The good news is that if it were something bad..I'd know it by
now..Thanks to all who were thinking of me and mailed me letters.I
really appreciated that.This group has been blessed with alot of
special caring individuals............love Skye

http://www2.netdoctor.co.uk/news/index.asp?y=2005&m=4&d=28&id=118787

Vitamin supplements taken by thousands of women to ward off the bone- thinning disease osteoporosis may be useless, research has found.
Two studies involving more than 8,000 elderly people who took vitamin D and calcium supplements daily for up to five years found they had no effect on strengthening the bones or preventing injury from falls. The finding is a blow to hopes that supplements could provide the answer to one of the major causes of disability and death among the elderly.
An estimated three million people have osteoporosis in the UK and 200,000 suffer fractures each year as a result. One in three women and one in 12 men over 50 will be affected over their lifetime.
Hip fractures caused by falls cost the NHS pounds 1.7bn a year. Almost one in three people aged over 65 reports having at least one fall a year, rising to one in two over the age of 80.
The National Osteoporosis Society said just last month that there was 'good research evidence' that a daily calcium and vitamin D supplement might be of use for people with osteoporosis over 75.
The first hospital-based study, published in The Lancet online, was of more than 5,000 participants from 21 hospitals around the UK, who had had at least one fracture within the past 10 years.
Professor Adrian Grant of the University of Aberdeen, who led the research, said: 'We have found no evidence that these supplements have a role to play. Instead we need to consider other strategies.'
The second study, of more than 3,000 women living in the community, published in the British Medical Journal, found the supplements had had no effect over two years.
Bones tend to lose their density after the menopause in women or as a result of falling testosterone levels in men. Drugs such as biphosphonates can slow this process and reduce the risk of fractures.
The researchers said further studies were needed on the effect of the supplements in first-line protection for people who had not yet had any fractures.

Something else to worry about
anterior atlantoaxial subluxation
"Rheumatoid cervical spine disorders are so common that cervical spine
radiographs should be taken in every patient with RA during the
disease course; they all are potential cases of [anterior atlantoaxial
subluxation] aAAS," Kauppi writes. "Patients with highly active
disease might be screened, for example, every third or fourth year
even without cervical symptoms."
Annette

I just watched this movie for the second time and I was wondering has
one else in this forum seen this movie. It's truly amazing and I
believe worth the time for anyone to watch. Makes you really think
about what is reality. If you ever questioned why it's so important
to feed your mind the correct thoughts this movie helps to explain
that. I'd love to hear what others think of the movie.
Susan Dorey
www.LivingWithRheumatoidArthritis.com

<< It's been going on
since Dec/Jan, and at that time everyone (drs) were
telling me it was the dry weather. I knew then that
that wasn't right, but couldn't convince anyone else
The doctors don't always know what they're talking about... I've run into
this kind of thing too. I may not have a medical degree but there is one
subject I'm an absolute expert on, and that is ME. I know me. I know my
whole history and every single ache and pain and odd feeling. I am not half
a chapter in somebody's textbook about rheumatoid arthritis. You may wear
the white coat but you really don't know much about how my body works and if
we have a disagreement about how I feel I will win every time.
I had a really bad and unusual reaction to an anti-nausea drug called
Compazine. It's called "akathisia" and is common with certain anti-psycotic
drugs but also occurs with Compazine and one other drug that's not related
to any of the others... begins with an R, I've forgotten the name. Reglan
maybe. Akathisia is a horrible feeling of near-psychotic anxiety and
restlessness and wrongness with everything in the world... people who've had
this reaction have been reported to rip out their IVs and run screaming
through the hospital naked. It's not that common with Compazine but it is a
documented and known effect of that drug in a very small percentage of
patients and I happened to be one. I tried to tell my doctor how I was
feeling but it's hard to make the words come out right. I felt anxious and
twitchy and my heart beat too fast and when I was sitting I wanted to be
walking and when I was walking I wanted to lay down and I always felt I
should be in some other place. It's so very hard to describe. And I knew
it HAD to be a chemical reaction to something because this was very
obviously not normal emotional anxiety or restlessness. It was a physical
disturbance and it was making me want to tear out my hair, very literally.
I did get a few chunks out one afternoon.
My doctor prescribed me an anti-anxiety medication that wouldn't kick in for
several weeks and sent me home. Obviously it didn't help. Then she tried a
stronger sedative and wanted me to see a counselor. I didn't have much luck
expressing to her that this was a physical problem and not the result of
stress. I would never have figured out what was wrong with me if I hadn't
coincidentally happened to read a friend's account in her online journal of
a feeling of WRONG and how the nurses at the hospital she was in immediately
recognized her symptoms as a Compazine reaction. I could have kissed her
for putting it into words so I could recognize what was wrong with me.
(I've pasted her words at the bottom of this post, with permission.)
I reported it to my doctor and she had never heard of anything called
akathisia and didn't know what I was talking about. I stopped taking the
Compazine immediately and within a few days I had lost the urge to claw my
eyes out and do the Polka on a major highway. I could have done serious
harm to myself or possibly others if the drug had built up in my system.
And my doctor not only didn't recognize the symptoms when I described them,
she had never heard of the problem at all.
The doctor is not always right.
Jenni
---
The story of Compazine, as told by my friend Danie:
Last year, I visited the ER for an allergic reaction to shellfish. One of
the drugs I received, Reglan, was to treat one of the results thereof, that
my digestive system had just completely stopped working. It got my stomach
gurgling again, but unfortunately, I suffered the kind of side effect I had
never in my life IMAGINED. Rob, figuring I was on my way to recovery, left
to grab some coffee. About two minutes later, I got the feeling that...
nothing in the world was right. I was miserable, physically and emotionally.
I sat up, because lying down was wrong. I stood up, because sitting was
wrong. I got back on the bed, because standing was wrong. I began to panic.
I began to whimper. I was all alone, and everything was WRONG. I ripped off
my blood pressure cuff and set to work on the things stuck to me to monitor
my heart. I was about to attack my IV when Rob returned, coffee in hand. I
looked at him and shrieked, "HELP ME!" He got a nurse.
The nurse came in and found me gesturing wildly at my IV. She examined it,
and it looked fine. She couldn't understand why I kept yelling, "It's bad,
it's bad, it's bad!" My regular nurse entered right then and realized what
was going on with me. Apparently, some people react this way to Reglan. I
got some kind of drug added to my IV, and within about five minutes, I felt
better, but embarrassed. The nurse told me that the last girl they had in
there who had the same reaction ended up ripping out her IV and running out
the ER doors, into the freezing cold, her bare butt hanging out of her gown.
So, yeah, it could have been worse.
And then... I started reacting the same way to this new drug that I had to
Reglan. Oh my deity, why does this shit always happen when I'm all alone?
Luckily, Lisa wandered in right then and knew from the way I looked that all
was not well. I started to cry. She asked me what I'd been given. She
grabbed a nurse. The nurse grabbed a doctor. The doctor yelled, "We have a
Compazine reaction over here!" I got some more drugs, which turned out to be
Benadryl and Ativan, Ativan being a tranquilizer.
That's the last thing I remember with any detail at all.

Please show me how to go back receiving messages as I did before. This is
too confusing to me. Kentucky Cowboy, are you there? I keep sending you
letters, but they come back undeliverable. ~Shelly

Hi there...thinking of you tomorrow when you have your appt with the
dr. Let us know what you hear. This is such a supportive group.
Try to relax a little tonight. See who's getting kicked off American
Idol. lol
You're in my thoughts and prayers.
Hugs...Paula Ohio (sun, rain for tomorrow?) Who knows..maybe 7 inches
of that white stuff!!

Hi Susan...the AutoImmune Disease website has a link on the left that says Request Information ( I believe) they will send you to another page and on the right hand corner there is a box that states "Cannot Afford". That will take you to a page that you can print out and request your info by mail for free. Looks like they would love your donation (of course) but they will send you back what you request.

Not fair..think it should all be free!!

Paula

Hi Eileen and Don....
I have had r/a for 22 years and am 57 .. feeling like 87. Has Eileen
tried injections in her shoylder? If I missed that...sorry. When my
knee becomes inflamed, my dr will drain it and give me a cortisone
injection. I usually have to get one once every 3 years or so. I only
get it when the pain is really bad. I'm already putting enough stuff
in my body for r/a.
She may be able to get her dr to give her an injection. I have had
them in my wrist and both knees. Ask your rheumy about it...if you
don't have a rheumatologist...get one. They're very knowledgeable and
treatments change all the time. I now have insurance but when I
didn't...I thought of going to the er and having their dr check me out
and maybe give me an injection if needed.
Hope this helps...Paula in (sunny, warm, cold, snowy, freezing, rainy)
Ohio

Dear Friends,
We would like to inform that there is a new website for Lupus and Arthritis diseases. The web address www.LupusArthritisIndonesia.org. You can also consult via email.

I hope will bring benefits to you all.

Regards,

Yusuf

www.aarda.org

This is a great site.

Paula
Ohio

Harold,.other friends,

I have developed neuralgia and need to see a neurologist. They suspect I've had a stroke. Won't know for sure til Thursday. Anyone know of any connection with this condition and the RA or Lupus? I sure could use your input and prayers. ~Shelly

I listen to what every one else is taking so I thought I would let
every one know what I was taking I am on plaquenil and remicaide 10
mg/kg prednidone traxodone to help me sleep and mobic plus a hole lot
of other for differant reasons Sherrie

Hello Don & Eleen,

And all other new people allso ,

Well as for the shoulder pain your wife has , I allso have it badly in the right shoulder , and at times it is very bad when aggervated it takes many weeks to months for mine to claim down to a more standable level and I was told a replacement was what I needed as jenny said earlier but I was at a between point not bad enought to have one and too bad to do anything for so I get the dep -mydol shots ( spelling might be wrong ) the help me a bit I allso have stage 4 and 2 O/A in my knees and need at least one replacement knee but too young there same shots there along with Decadron , but they only claim my pain for a few days or weeks at best if i'm lucky . I must be starting a flare now since I was hurting badly this after noon and cannt sleep tonite thus this 3 am puter visit LOL but what I was wanting to tell you eill follow .

I suffered migrians affull my whole life till about 6 yrs ago and spent most of my younger adult life seeing specialest trying new meds for them and nothing worked , then my adult life I too foulnd imtrex which helped but didnt stop me from getting them case they came so fast for me and I was one who had one most EVERY WEEK if not I never missed two weeks but i got high blood pressure and got put on ( bisospher htc ) and after all those years that med stoped my migrians completly , didnt come back till they took me off it because my blood pressure got ok then they came rite back so now I still take it every day for my migrine controll , if you would like to dicuss it with your wife and her dr let me know and ill get you the non generitic name and right spelling but i know the same thing dont work for everyone but if hers are like mine where I would of tryed anything .

john

I know I need to research this more but I'd like to get a personal perspective:
My new Rheumatologist told me I need to be off Humira when I am trying to
have a baby, my old Rheumatologist told me I can be on it until I actually
conceive. Now I don't know what to think! I see how quickly my RA comes
back after just one missed dose. I can't imagine being off it for the months it
would take me to conceive!
If anyone has been on the TNF blockers and trying to have a child or if
anyone knows about this, I would like to hear from them!
Thanks!
Eliz

Yes, my hands are crooked, deformed. My feet too.... It's pretty
impressive. lol I just have been having lots of pain in my knees and
feet and hand too.
Paula

thanks for tasty tips!The best kind, i doubt I can afford it. I know I
can't. I'm dirt poor and an idiot. Just click on my name to your right
there's my pic. Does anyone besides me feel Harold and Nina are the
smartest freaks on the
planet!? Yea! I'm 13yrs into RA, had Sulfasalazine and Aleve in the
beginning. Remember bitter old me,"Lose weight.." Why Dr, I don't
walk on my fingers and THEY hurt. Can POOR people get Remicade? I'm
counting Bextra pills till I go back in May. I wasn't always poor, but
I was dumped when my hubby of 16 yrs heard my diagnosis. I survived
on child support without ever being on welfare. Stayed home with 2
kids lost my LVN liscense(who can work when their arms are dangling by
threads? Help me decide , whats it gonna do cripple me? I've had bad
advice and made decisions that at the time I thought were right.
Newspaper articles of the "cure" and breakthrough Cox-2's were coming
out and I held on for them. Signing off have depressed my self. One
thing if you are deciding on a mattress pad go to Walmart or the like
ang price foam egg-shell looking foam for a chevch-book price until
you are ready to make bigger Sleep-system purchases. They cut easy
with scissors or my son claims, I can't tackle that,and will fit a
chair, your car, almost adaptable for quick relief. $$$$$help. Loads
of love to everyone. I don't have the net so Tuesdays are good till summer
school.

Welcome, Loucretia and Don!
Don, I think its very nice that you have joined this for your wife! I hope she
will
check us out too because we are a great support system!
I am currently doing Acupuncture so I am the Guinea Pig! I had 3 sessions
and felt improvement in my pain levels, but then my Doc went to a 2 week
conference and with scheduling problems, I could not get a treatment for a
month! So, I am back to Square 1 again, but determined to try again! I am
doing it mostly for my Fibromyalgia and Costochondritis, though, not so much
the RA as when I am able to take my Humira, do quite well with that.
I would recommend your wife give it a try though, and would suggest an MD
who does Acupuncture.
Elizabeth

Got blood work results...always the normal..anemia etc. My sedrate is
high at 100. I am in a lot of pain in feet, hands and knees. Has
anybody else had this high of a sedrate?
Dr is going to put me back on enbrel or humira imitation whatever that
is....unless i read his handwriting wrong..you knows docs. lol I will
call him tomorrow.
Hugs..Paula

Hello everyone,
I'm sorry I have not posted in ages, in fact, I'm sure most of you probably do not remember me.

My name is Linda. I am 49, I have RA. It has been hitting me quite bad the past year.
I am going to my Rheumy tomorrow. I hope he can help me some. My right shoulder
has been hurting me terribly the past three weeks.

I hope everyone is having a good day.

Hugz, Linda

Hi, I'm new to the group, but I've been lurking a few days. I'm
actually doing this for my wife who has had RA since she was a kid.
She's now 52 and it's gotten waaaaay worse in the past 4 or 5 years.
She's pretty much in constant pain now. Taking lots of meds (which she
doesn't like to do). Her main prob right now is her right shoulder.
It hurts all the time, but when she lays down it totally throbs and
she can't sleep at all. Any suggestions on getting comfortable while
lying down would be appreciated.
I've done a little searching of back messages without too much
success. I'm wondering if you guys could comment on a couple things...
1. She's thinking of trying Accupuncture. Has anyone had any success
with AP? Are there any things to look for or avoid in a AP?
2. We've read about the TENS machines that are battery powered devices
that connect to your skin via wires, and electrically stimulate your
muscles to mask pain. Any experiences with those?
Thanks for any help you can give,
Don

Just wanted say Hello
I am a 31 year old lady with RA.
I have 2 children and happily married.
But this is a very difficult disease and I was looking for others who
have it.
God Bless,,Loucretia
Look forward to your post

I haven't posted in a while. I switched to a new RA in March and love
him. He is so nice and understanding. He put me on Plaquinal (?). He
said if it worked, it would take 3-6 months, so somewhere inbetween May
and Sept. I will hopefully feel some relief.
this past weekend I had a Hot Stone Massage. That gave me tremendous
relief! My hands still don't hurt today and I had the massage on
Saturday. I'm going to try and get one every couple of months, since I
felt so good after.
Laura

I hope that you will get some answers soon. I know I am always anxious
waiting for bloodwork results. I have to call in today to see what the
dr thought of my bloodwork and what meds to put me on. He only has me
on 5 mg prednisone now. So, we will see.
I hope you're feeling better today. I'm sure that if the dr decides
togive you laix or drain the fluid..you will feel much better.
Loads of snow in Ohio....it's horrible. My joints were starting to
feel good and then the barometic change and temperature change.
UGH!!!!!!!!!
Hugs to you and let us know how you are feeling...
Paula in Winter Wonderland

how are you feeling today? any good news yet?? gentle hugs, Marcia
oh, and alos, has anyone heard from Jacy gal lately?

Well wish I had good news..but I have no news as of yet. I go back
to the Dr on Thursday. In the meantime I am blowing up like a
ballon,in the abdomen.It hurts my legs to walk.carrying the extra
weight.Everyone is saying it definitly is Ascites..I have a feeling it
is too.But that could be caused by a number of things..I donot think I
will die an agonizing horrible death..Sorry Chaos..lol Thank you all
for sharing your well wishes and concerns.Welcome Eileen..Skye

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I looked for that post but don't remember whose it was. I did find one
exchange that may be useful when you get lower...
Have your doc prescribe the 1 mg pills.
It is too inaccurate to break the fivers down.
You can break the one mg into quarters...inagine the difference in
tapering ability! !
Pris
When I was on 5mg Prednisone, I used to divide that tiny little tablet
into 4 pieces and reduced the dosage by only 1/4 tablet at a time.
Good luck to you all.
Annette

A Big thank you..Will find results later today.Appt at 3pm mtn time
so it will be in the evening for the east coast.Will keep you posted.
(((((((((((((((((((((BIG GROUP HUG)))))))))))))))))))
)))))))))) Skye

Well Had the Ct scan done..drank that nasty stuff..yuukkk.I was
suppose to see the Dr at 9am but it has been bumped down to 3pm.Bad
morning for pain.Had to deplete my arsenal in order to get rid of said
pain.Thank you all who were an are concerned.This is a special group
of people.Oh Hi to Eileen is it? Sorry you had to join us but happy t
hat you have . Make sense? What a day to be wrapped from arms in ace
bandages to knees with braces it is rather warm here to say the
least.Not complaining though .Better than the snow back east..I am a
bit apprehensive about hearing the results but.Hay as one put it..Am I
going to die a horribly painful death? lol love you girl....Skye

this morning I woke up in pain in my right shoulder and elbow it hurt
so much that i couldn't sleep it did let up after an hour i am going
to call the doctor and go get it injected i hope today any ideas how
to help the pain untill monday if i don't get in to see the doctor
today it happens every morning some hurt more than others thanks
Sherrie

How are you doing my friend? We have been thinking and praying for
you.
Hope you received good news. Let us know how you are..you've been in my
thoughts all day yesterday and today.
Hugs..Paula

Hello one and all.
I am new to the group, but have been living with RA for over 7 years.
I am a 41 year old woman who has had chronic migrianes for 34 years
and have develped a B vitamin def. as well. One of my major problems
is that I am allergic to many NSAIDS and opiates.
Eileen/Ciar/DarkRaven
-we are the Morrigan

Thank you for the good thoughts.
Our weather is going to be between 30 and 45 this weekend. This is
definitely how people end up sick. Maybe this will be the last blast
from Mother Nature. David has a car show this weekend...luckily it is
inside a huge dealership in Cleveland but he still has to drive the car
he is going to show up there. Poor guy..that doesn't make him a happy
camper.
Hope you have a nice TGIF and weekend...
Paula

Drinking Tart Cherry Juice: Does It Really Help Arthritis Pain?

Prev Med. 2003 Feb;36(2):243-9.
Glucocorticoid-induced osteoporosis: pathogenesis, diagnosis, and
management.
McIlwain HH.
Tampa Medical Group Research, 4700 N. Habana Avenue, Suite 303, Tampa, FL
33614, USA. hmcil@...
Glucocorticoid-induced bone loss is dose- and duration-related, develops
rapidly (within months of therapy), and leads to an increased risk of
fractures. Moreover, less than one in four patients prescribed oral
glucocorticoids receive any treatment to prevent or treat osteoporosis. The
American College of Rheumatology recommends bisphosphonate therapy to
prevent bone loss in most patients beginning long-term glucocorticoid
therapy (prednisone equivalent of
in men and postmenopausal women receiving long-term glucocorticoids who have
an abnormal bone mineral density (T score below -1). Patients with
glucocorticoid-induced osteoporosis are at particularly high risk for
fractures, and should be treated aggressively to reduce fracture risk.
Risedronate is approved in the United States for both prevention and
treatment of glucocorticoid-induced osteoporosis and alendronate is approved
for treatment. Both drugs increase bone mass in patients with established
glucocorticoid-induced osteoporosis. Risedronate has been shown to
significantly reduce the incidence of fractures after 1 year of treatment.
Prevention or treatment of glucocorticoid-induced bone loss is recommended
for patients at risk.
PMID: 12591000
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12591000&itool=iconabstr

You do have a great sense of humor!! You're only 40. I was dx when I
was 35 years of age...22 years ago. It was not too bad then but these
last few years have been heck. This auto-immune stuff isn't much fun.
There's always something new going on with me anymore. Guess it keeps
the doctors on their toes. LOL
Take care....Keep up your good attitude...
Paula

Blocking a single protein might stop cartilage destruction in both RA and OA
April 5, 2005
Rheumawire
Janis Kelly
Victoria, Australia, and Cambridge, MA - A pair of papers in the March 31,
2005 issue of Nature establishes that the aggrecanase ADAMTS5 is the prime
cause of cartilage destruction in animal models of both osteoarthritis (OA)
and rheumatoid arthritis (RA) and that knocking out this single protein
dramatically reduces cartilage deterioration in vivo. [1,2]
Enzymes that contribute to the breakdown of aggrecan have long been an
object of research interest because aggrecan and type 2 collagen together
provide cartilage its characteristic toughness and elasticity.
Route to a DMARD for osteoarthritis?
The osteoarthritis study was by Wyeth scientists led by Dr Elisabeth Morris,
director of the company's osteoarthritis, women's health, and bone
therapeutic research. "We created a mouse with inactive ADAMTS5
(aggrecanase-2), and these mice did not develop osteoarthritis after
surgical induction of joint instability. This is the first report in the
literature of a single gene deletion that affected the course of
osteoarthritis," Morris tells rheumawire.
The researchers first made ADAMTS5 knockout mice, then caused unilateral
joint instability by surgically transecting the medial meniscotibial
ligament in a group of these mice and in a control group of wild-type mice.
This model typically produces OA-like cartilage deterioration within a few
weeks. Mice were sacrificed at 4 and 8 weeks after surgery, and joint damage
scores were compared.
The ADAMTS5 knockout mice had significantly less cartilage damage than the
wild-type mice at both time points. Furthermore, when the researchers
cultured bits of femoral head articular cartilage with proinflammatory
modulators IL-1alpha and retinoic acid, those from wild-type mice showed a
significant increase in release of total proteoglycan, a sign of cartilage
degradation, but those from ADAMTS5 knockout mice did not. Interestingly,
deleting ADAMTS5 did not alter the growth or development of the mice,
suggesting that targeting this enzyme might be a viable therapeutic
strategy.
"ADAMTS5, or aggrecanase-2, is an enzyme made by chondrocytes that causes
degradation of aggrecan during pathologic joint disease. The goal of a
therapeutic intervention would be inhibition of this enzyme with a small
molecule taken orally," says Morris.
Morris says that the researchers were surprised to find that ADAMTS5 appears
to be the only enzyme involved in aggrecanase-mediated destruction of
aggrecan in OA mice, as they had suspected that both ADAMTS4 (aggrecanase-1)
and ADAMTS5 (aggrecanase-2) were responsible.
"We will have to work hard to verify that the only aggrecanase in human OA
is ADAMTS5, as pathogenic mechanisms in mice do not always directly
translate to the human condition," Morris warns.
ADAMTS5 knockout also protects joints in RA mice
Dr Amanda J Fosang led the University of Melbourne (Victoria, Australia)
Johnson & Johnson (San Diego, CA) researchers who reported that deleting
ADAMTS5 also prevents cartilage damage in a mouse model of RA
(antigen-induced arthritis).
"We now know exactly which enzyme is involved in destroying cartilage in
arthritic diseasewhether it be osteo- or inflammatory arthritis. The big
advance here is that now the drug companies know what it is they are trying
to inhibit, and they will be able to take a more targeted approach to
designing inhibitors," Fosang tells rheumawire.
The Melbourne group established that ADAMTS5 is the major aggrecanase in
mouse cartilage, both in vitro and using the antigen-induced arthritis model
of inflammatory arthritis.
Both Fosang and Morris suspect that targeting ADAMTS5 is likely to be highly
effective in OA and necessary but not sufficient in RA. Fosang points out
that severe, end-stage inflammatory arthritis is associated with the
generation of matrix metalloproteinase (MMP)-derived aggrecan fragments, so
the MMPs are also important.
"It is likely that ADAMTS5 is involved in final cartilage destruction in
both OA and RA, although inhibition of aggrecanase alone would probably have
less beneficial effect in RA because of all the other destructive
inflammatory mechanisms at play," Morris adds.
Wyeth and other pharmaceutical companies have been hot on the track of
aggrecanase inhibitors for several years. Most efforts have focused on
inhibitors that block the activity of already-activated ADAMTS5, but Fosang
suggests another strategy. "Another angle is to look at how the enzyme is
activated, and this is where we are going," she says. "It may be more
effective to block activation, rather than try to block the actions of an
already-active enzyme."
Sources
Glasson SS, Askew R, Sheppard B, et al. Deletion of active
ADAMTS5 prevents cartilage degradation in a murine model of osteoarthritis.
Nature 2005; 434:644-648.
Stanton H, Rogerson FM, East CJ, et al. ADAMTS5 is the
major aggrecanase in mouse cartilage in vivoand in vitro. Nature 2005;
434:648-652.

September 08, 2003
Summary of a presentation at the Living with RA Workshop
Stephen A. Paget, MD, FACP, FACR
Physician-in-Chief and Chairman of the Division of Rheumatology
Hospital for Special Surgery
The Joseph P. Routh Professor of Medicine
Weill Medical College of Cornell University
"How Medication Decisions are Made in RA Treatment":
http://www.hss.edu/Conditions/Rheumatoid-Arthritis/How-Decisions-Are-Made-In-Ra-Treatment

"Arthritis and its Effects on Speech":
http://webpages.marshall.edu/~kiser5/arthspch.htm

Hospital for Special Surgery
Stephen A. Paget, MD, FACP, FACR
February 14, 2003
"An In-depth Overview of Rheumatoid Arthritis":
http://www.hss.edu/Conditions/Rheumatoid-Arthritis/Rheumatoid-Arthritis

Even Low Steroid Doses Can Be Trouble
Fractures tied to common arthritis, asthma drug
By Julia McNamee Neenan
HealthScout Reporter
MONDAY, Oct. 23 (HealthScout) -- Daily low doses of a commonly prescribed
oral steroid, prednisone, can double your risk of hip fractures and
cataracts, scientists reported today. Researchers have long known of the
link between higher doses of oral steroids and dangerous side effects, but
the new study shows the potential for side effects at much lower doses, says
Dr. John B. Wong, an associate professor of medicine at Tufts-New England
Medical Center in Boston.
The problem is that prednisone and other steroid medications are critical in
managing diseases in which inflammation plays a painful role, Wong says.
"Low-dose steroids are used commonly in a number of diseases, including
patients with asthma or rheumatoid arthritis," he says. Prednisone also is
used to treat Crohn's disease and other inflammatory bowel disorders.
Wong stresses that people who are taking this medicine should not stop doing
so based just on these new findings.
"If patients are worried about the long-term side effects, I'd encourage
them to discuss it with their doctors," Wong says. "The benefits of the
medicine might clearly outweigh the risks."
The study tracked the progress of 4,993 people with rheumatoid arthritis for
15 years, monitoring their medications and subsequent health.
Those who'd taken 5 milligrams to 10 milligrams of prednisone a day were
twice as likely to break their hips and 2½ times as likely to develop
cataracts as those who had taken no prednisone, the study says.
And those who'd taken the steroid at these low doses for three or more years
were 3.2 times as likely to develop cataracts as those who had not taken
prednisone, it says. Findings are being presented today in San Francisco at
a meeting of the American College of Chest Physicians.
People with rheumatoid arthritis take prednisone orally, while people with
asthma usually inhale the medication. But Wong says other tests have shown
that the body absorbs the two forms of medicine similarly.
Prednisone is so commonly used that more than half of the participants in
the study used the medication at one point or another, Wong says.
However, Dr. Jefrey Lieberman, director of the Arthritis Care Center in
Atlanta, says the drug is used less frequently today than it was when Wong's
study started in 1982. Lieberman estimates that just 10 percent of his
patients use the drug at any one time.
The side effects of prednisone at higher doses have been known for some
time, he says. So, while the medication was first seen as a miracle cure,
today it's prescribed with more caution, Lieberman says.
About 2.1 million people in the United States are diagnosed with rheumatoid
arthritis.
Prednisone doesn't affect the progress of the disease, "but nothing works
better to reduce inflammation quickly than prednisone," Lieberman says.
Doctors constantly are attempting to determine the "magic dose," or how many
milligrams of the medication best help someone without bringing on side
effects, he says.
Attempts to reach Schein Pharmaceuticals, which manufactures Prednisone,
were unsuccessful.
What to Do
Lieberman says other oral steroids could be presumed to affect your hips and
eyes as prednisone did in this study. These steroids, called
corticosteroids, differ from anabolic steroids, which bodybuilders sometimes
use to pack on muscle power.
If you and your doctor determine that prednisone or another oral steroid is
useful for your health, despite its side effects, your doctor will want to
monitor you closely, Wong says. In keeping an eye on the health of your
bones, for example, and to prevent osteoporosis, your doctor will want to
make sure you have enough vitamin D and calcium in your diet. If
osteoporosis begins to develop, your doctor may prescribe hormone
replacement therapy or another medication to beef up your bones.
Similarly, to protect against cataract formation, your doctor may recommend
you shield your eyes from ultraviolet light exposure as much as possible,
usually by wearing sunglasses.
http://www.cushings-help.com/prednisone-danger.htm

Arthritis Research Campaign
2004
"The use and Abuse of Steroids in Rheumatology":
Excerpt:
Oral steroids are often used in rheumatoid arthritis for patients refractory
to other treatments and in the elderly, in whom they may be better tolerated
than NSAIDs. There has been debate as to whether steroids should be
introduced early in the course of the disease. Although some patients
benefit symptomatically from the addition of low-dose oral prednisolone to
second-line drug therapy, this improvement is not sustained beyond 6 to 9
months. A significant rebound flare in disease activity as the dose is
tapered may prevent steroid withdrawal, resulting in concerns about
long-term toxicity. Kirwan (1995) has reported that the addition of low-dose
prednisolone (7.5mg daily) to standard treatment in early, active rheumatoid
arthritis slows radiological development and progression of erosions.
However, we do not know if the potential benefits are maintained beyond the
treatment period, nor if they are outweighed by long-term side effects. At
present, there is insufficient evidence to warrant widespread prescription
of steroids in early disease; further studies are awaited.
http://www.arc.org.uk/about_arth/med_reports/series3/pp/6338/6338.htm

Rheumatology (Oxford). 2005 Mar 15; [Epub ahead of print]
The cost of glucocorticoid-associated adverse events in rheumatoid
arthritis.
Pisu M, James N, Sampsel S, Saag KG.
Center for Outcomes and Effectiveness Research and Education (COERE),
University of Alabama at Birmingham, USA.
Objective. To estimate the costs of glucocorticoid associated adverse events
(GAEs) in patients with rheumatoid arthritis (RA). Methods. We conducted a
literature review of studies reporting GAEs in RA patients, and developed a
Markov model with the following GAEs: fractures (vertebral, hip, pelvic),
hypertension, diabetes, gastrointestinal complications, pneumonia, urinary
tract infection, cataract and, in an extended model, myocardial infarction
(MI) and stroke. Two-year total costs were calculated using direct medical
costs (2001 US dollars) and by running 10,000 Monte Carlo simulations with
probability values randomly selected from the GAE literature. Results. On
average, glucocorticoid users spent \$445 more than non-users, or \$0.46 for
each dollar spent on purchasing the drug. When adding MI and stroke, users
spent on average \$430 more than non-users, or \$0.44 for each dollar spent
on purchasing the drug; this incremental cost ranged from \$193 to \$682 if
MI and stroke were excluded, respectively. In 70% of the simulations there
were more deaths among users than among non-users, in both the model with
and without MI and stroke.
Conclusions. Although results varied depending on attributed GAEs, in
general glucocorticoid users spent more than non-users on GAE treatment, and
had higher mortality. Patients, providers and policy makers should consider
these potential costs of GAEs when making treatment decisions.
PMID: 15769791
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15769791&itool=iconabstr

Arthritis & Rheumatism
Official Journal of the American College of Rheumatology
Volume 39, No. 11, November 1996, pp 1791-1801
Excerpt:
It is generally accepted that moderate-to-high-dose glucocorticoid therapy
is associated with loss of bone and increased risk of fracture. Skeletal
wasting is most rapid during the first 6 months of therapy; trabecular bone
is affected to a greater degree than cortical bone. The skeletal effects of
glucocorticoids appear to be both dose and duration dependent, with daily
prednisone doses of [lte]7.5 mg often resulting in significant bone loss and
increased fracture risk (17-24). The cumulative dose also affects the
severity of bone loss. It is not known whether there is a threshold dose of
glucocorticoid below which osteopenia does not occur; alternate-day
glucocorticoid regimens, however, have not been shown to produce less bone
loss than daily regimens (25,26). Even inhaled steroids have been shown to
increase bone loss (27-29).
The magnitude of this problem has been demonstrated by cross-sectional
studies, which suggest that the majority of patients receiving long-term
glucocorticoid therapy have low bone mineral density, and that over
one-fourth sustain osteoporotic fractures. The prevalence of vertebral
fractures in asthma patients receiving steroid therapy for at least 1 year
is 11% (17), and steroid-treated patients with rheumatoid arthritis have an
increased incidence of fractures of the hip, rib, spine, leg, ankle, and
foot (20-22). Thus, glucocorticoid-induced osteoporosis is an important
clinical problem which commands the physician's attention to both prevention
and treatment.
http://www.rheumatology.org/publications/guidelines/osteo/osteo.asp?aud=mem

Ann Rheum Dis. 2004 Jul;63(7):797-803.
Lack of radiological and clinical benefit over two years of low dose
prednisolone for rheumatoid arthritis: results of a randomised controlled
trial.
Capell HA, Madhok R, Hunter JA, Porter D, Morrison E, Larkin J, Thomson EA,
Hampson R, Poon FW.
Centre for Rheumatic Diseases, Glasgow Royal Infirmary, North Glasgow
University NHS Trust, Castle St, Glasgow G40SF, UK.
Hilary.Capell@...
BACKGROUND: Evidence for disease modifying activity of low dose
corticosteroid treatment in rheumatoid arthritis is contradictory. Studies
showing radiological benefit suggest that continued treatment is required to
sustain the effect. OBJECTIVE: To evaluate the effect of low dose oral
prednisolone in early rheumatoid arthritis on disease activity over two
years. DESIGN: Double blind placebo controlled trial. METHODS: Patients with
rheumatoid arthritis, duration <3 years (n = 167), were started on a disease
modifying antirheumatic drug (DMARD; sulphasalazine) and allocated by
stratified randomisation to prednisolone 7 mg/day or placebo. Primary
outcome measure was radiological damage, assessed by the modified Sharp
method. Clinical benefit was a secondary outcome. A proactive approach to
identifying and treating corticosteroid adverse events was adopted. Patients
who discontinued sulphasalazine were offered an alternative DMARD. RESULTS:
90 of 257 patients eligible for the study refused to participate (more women
than men). Of those enrolled, 84% were seropositive for rheumatoid factor,
median age 56 years, median disease duration 12 months, female to male ratio
1.8:1. Prednisolone was given to 84 patients; of these 73% continued
prednisolone and 70% sulphasalazine at 2 years. Of the 83 patients on
placebo, 80% continued placebo and 64% sulphasalazine at 2 years. There were
no significant differences in radiological score or clinical and laboratory
measures at 0 and 2 years.
CONCLUSIONS: Low dose prednisolone conferred no radiological or clinical
benefit on patients maintained on a DMARD over two years. Low dose
corticosteroids have no role in the routine management of rheumatoid
arthritis treated with conventional disease modifying drugs.
PMID: 15194574
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15194574&itool=iconabstr

Pharmaceutical Research
Low-dose steroids are neither safe nor effective for long-term treatment of
rheumatoid arthritis
Doctors should abandon the use of low-dose glucocorticoids such as
prednisone as an antiquated approach to the treatment of rheumatoid
arthritis (RA) in favor of more targeted and safer RA treatments, recommends
Kenneth G. Saag, M.D., M.Sc., in a recent commentary. He contends that
long-term low-dose glucocorticoids, a type of steroid, simply do not work
(their antiinflammatory benefits decline considerably after the first year),
and they can cause undue adverse effects and toxicity. High on the list of
problems is the dramatic bone loss and resulting fracture risk from
prolonged glucocorticoid use. Yet few RA patients are being evaluated and
treated for this potential complication.
One study estimated that more than half of glucocorticoid users develop bone
loss leading to fracture. Other studies have suggested a mean first-year
loss of bone of up to 15 percent at the dose range of 10 mg per day or less
of prednisone and up to a loss of 3 percent per year in subsequent years.
Another study found that 34 percent of women on a mean dose of prednisone of
8.6 mg per day had suffered a fracture within 5 years of followup.
Cataract is another well-described complication of prolonged glucocorticoid
use. Cataract may develop even when inhaled glucocorticoids are used. In
addition, increased intraocular pressure may develop in these patients,
increasing the risk of glaucoma.
Long-term use of low-dose glucocorticoids also may lead to development of
premature atherosclerosis. One study found a three-fold increase in
atherosclerosis in RA patients treated with glucocorticoids compared with
nonsteroid-treated patients. Biologic response-modifying drugs are now
available to treat RA, such as methotrexate, leflunomide, etanercept, and
infliximab. When the serious problems associated with glucocorticoids are
adequately explained, patients' perceptions of and preference for their use
may change markedly, says Dr. Saag. His work at the Center for Education and
Research on Therapeutics of Musculoskeletal Disorders, University of Alabama
at Birmingham, is supported in part by the Agency for Healthcare Research
and Quality (HS10389).
More details are in "Resolved: Low-dose glucocorticoids are neither safe nor
effective for the long-term treatment of rheumatoid arthritis," by Dr. Saag,
in the October 2001 Arthritis Care & Research 45, pp. 468-471.
http://www.ahcpr.gov/research/feb02/0202RA2.htm

ACR: Prednisone Risks Significant for Pneumonia in Rheumatoid Arthritis
Patients
By Bruce Sylvester
SAN ANTONIO, TX -- October 22, 2004 -- Rheumatoid arthritis patients being
treated with prednisone have a significantly higher risk of developing
pneumonia than patients using biologic medications, researchers reported
here on October 20th at the 68th Annual Scientific Meeting of the American
College of Rheumatology.
"While it is good news that the increased rate of pneumonia in people taking
biologics is relatively low, the risk of pneumonia associated with
prednisone use is substantial," said investigator Frederick Wolfe, MD,
director, National Data Bank for Rheumatic Diseases, Wichita, Kansas. "This
means that rather than being a relatively benign therapy, prednisone appears
to be a significant contributor to the risks associated with development of
pneumonia in the treatment of rheumatoid arthritis."
Dr. Wolfe and colleagues undertook a 2 and a half year study that compared
the risks of biologic therapy and prednisone use in 15,966 patients with
long-term arthritis and an average age of 60.5 years. The investigators
evaluated patient responses to semi-annual questionnaires that were also
validated by analysis of medical and death records.
Results show that 53.0% used a biologic agent, 18.7% used
hydroxychloroquine, 55.7% used methotrexate, 32.4% used a disease-modifying
antirheumatic agent (DMARD) without a tumor necrosis factor agent, 10.2%
used neither a DMARD nor a biologic agent, and 38.4 % used prednisone with
or without other agents.
Dr. Wolfe reported that subjects who used biologic drugs were 30% more
likely to get pneumonia, and subjects who used prednisone were 170% more
likely to get pneumonia compared to subjects who used other treatments.
An estimated 35% to 45% of patients treated for rheumatoid arthritis
currently use prednisone, and more than 70% of patients will use it at some
point, Dr. Wolfe said.
Functional status and disease severity was somewhat predictive of infection,
but the study results suggest that steroid therapy could play a larger
detrimental role than previously known, he noted.
"These data indicate an increased risk among biologic users, but also
demonstrate a much larger risk from corticosteroids, and suggest more
attention should be paid to this commonly used but less safe therapy, he
concluded.
[Presentation title: Rates and Predictors of Pneumonia in Patients With
Rheumatoid Arthritis: Strong Association With Corticosteroid Therapy.
Abstract 1763]

Scottish Intercollegiate Guidelines Network
Management of Early Rheumatoid Arthritis
Summary of recommendations
Corticosteroid therapy
Oral corticosteroids are not recommended for routine use, as there is
no sustained clinical or functional benefit and there is high risk of
toxicity with long term use.
Inform patients of the risks of corticosteroids prior to
prescription and issue steroid warning card.
Intramuscular corticosteroid allows control of dose and duration
of therapy and may be preferable to oral therapy.
Oral corticosteroids should