Treatment to Keep Arthur Subdued

Those of us with RA sometimes like to refer to our disease as "Arthur"...get it? Arthritis sounds like Arthur? :D Okay, so it's not exactly laugh-out-loud funny, but a little sarcasm never hurt anyone. What do you expect from a group of people living with a chronic and painful disease? We need humor. If we don't laugh, we might cry. I think we can all agree that laughter beats tears anytime. So, we personify our disease and refer to it as if it's a living and breathing entity all its own. RA can certainly feel this way at times, because it's always with us. There are a lot of different treatment options, but Arthur doesn't always respond to them or may only respond for a limited time. He's always hanging around, impacting our daily lives to a greater or lesser degree, being kept at bay with medication or raging through our bodies unchecked.

Arthur is a sneaky little devil. He can be subdued for a long time, and just when you start to forget about him "he taps on your shoulder (or any other joint or organ for that matter) and says, 'Hey, I'm still here!' Let's just say it's a little annoying!" (quoted from a friend of mine). Arthur also does the majority of his damage on the inside of us, making ours an Invisible Disease. In other words, it's usually not immediately obvious from looking at us that we have RA. Unless we have massively swollen joints, you might not notice anything unusual about us. You can't see the disease eating away at our joints, or inflaming our lungs to make breathing harder, or inflaming our heart and upping our chance of a heart attack. You can't see the fatigue, the low-grade fever, the full medicine cabinet that allows us to function. It's often invisible but no less real. There is one excellent blog that focuses on this, www.butyoudontlooksick.com. Written by a woman with lupus (similar to RA in a lot of ways), the blog describes what life is like when you don't look as sick as you truly are.       

Treatment for Arthur is complicated because there are a lot of factors in play. How effective is the treatment? How costly is it? What are the potential side effects? How does the treatment help with both the short-term and long-term consequences of RA? These must all be considered, there are no easy answers, and RA patients must make decisions about treatment for themselves because it is very personal. What works for one person with RA doesn't work for another. What works at one time for one person with RA doesn't work later on, because drugs lose their effectiveness or our bodies build up a resistance to them. For some, the benefits of a drug outweigh the risks. For others, the high financial cost of a drug may make it an impossibility. Of course, there is a lesson here - when making decisions that impact our health, it's good to be a little selfish. We have to live in our bodies and we have to feel confident about the medications and treatments that we choose. Your neighbor who tells you that a mango drink twice a day will cure you? Pay her no mind. You cousin who thinks it's all in your head and can't understand why you take such expensive and dangerous medication? She doesn't have a disease attacking her body from the inside out, so it's very easy for her to roll her eyes. Even your doctors don't fully understand what you're going through. Some do more than others, of course, and they usually mean well. But don't let them pressure you into the newest drug that promises a miracle - it's your life. 

There are the day-to-day struggles to be faced; extreme fatigue and pain are chief among them. Even for those like me who live a relatively normal life with RA, the fatigue is something we constantly battle. There isn't much to do other than take it easy, get plenty of sleep at night, and rely on caffeine. I need at least 9 hours of sleep at night to really wake up feeling refreshed the next day. Some people with RA need even more rest, especially if they're having a flare (that's the term for when RA is really active - it could be a few weeks at a time, a couple months, or for the ones who really hit the jackpot it could be that they live everyday in a flare, never seeming to find treatment that works for them). 

Then there is the pain that most people with RA live with, which is usually lessened by medication. Drugs like NSAIDs (pronounced "n-sad") taken at a high dosage can really help. Naproxen is one such NSAID that many of us take; I take 500 milligram tablets once a day. You might recognize Naproxen as the main ingredient of Aleve, except that in Aleve it is only available in 200 mg tablets. Let's look at that name for a second - NSAID stands for "non-steroidal anti-inflammatory", meaning that it works differently from a steroid drug and it works to combat the inflammation the RA causes. This is significant because steroids can also be taken for pain management. Prednisone is a commonly prescribed steroid, and it's usually taken at a high dosage for a short period of time during a flare...*sigh* Ahh, prednisone. We love it and we hate it! It can make you feel like a superhero, but it also makes you eat everything in sight so that you inevitably gain 5-10 pounds. It can affect your mood drastically, so that PMS feels like a peaceful holiday in comparison. My friend, Carol, has a great blog about her experience with RA, and you might like her assessment of prednisone: www.tenn2texas.wordpress.com. 

Then there is the depression. Let's be real right now and admit to ourselves that half the country is taking anti-depressants. It isn't something to be ignored or whispered in hushed tones, it's a reality. It's even more prevalent among people with an incurable, lifelong, painful disease such as RA. Most of my friends with RA take Zoloft or some other anti-depressant medication and find that it helps them. I'm extremely fortunate to have a mild case of RA and I can lead a life closer to normal than many of them. But faced with pain every single day that ranges from  a throbbing 3 on the pain scale to a gnawing 13.5? That would likely depress me, too. During my last flare in 2010, I had a supportive family and a happy life (and still do!) - these are a huge help! Others aren't as fortunate, and I believe depression finds them quickly when their family is unsupportive and other stress factors are in place.

Equally important, there are numerous treatment options for the long term consequences of RA. Even if our day-to-day pain, fatigue, and depression can be managed, that is only the beginning. We have to do all we can to prevent further damage to our joints and organs, or we risk making our situation much worse. Thankfully, there are medications that can suppress our overactive immune system and help slow the inflammatory process. Maybe we can keep the disease from moving onto different parts of our body with these drugs and a little hoping and praying. None of these drugs comes with a guarantee, though. In fact, they come with more side effects and risks than we would like. I'll write more on this important subject later, but for now I'll bring this long post to a close. More on the pricey and dangerous treatments of RA coming up soon! For now, here's wishing everyone a happy fourth of July weekend!! :D

Bittersweet Diagnosis and Living with "the other Arthritis"

Most diseases progress like this: diagnosis, treatment, cure. In my lifetime I sincerely hope to see that third and final stage happen for me and all the rest of my arthritic friends. Anyhow, getting the diagnosis is a big step for anyone. It's a little bittersweet because it involves feeling enormous relief ("Thank God! This thing has a name and I'm not the only one in the world to have experienced it!") followed by overwhelming helplessness ("There's no cure??...Wow, There's no cure - now what?!).

This helplessness is exacerbated by the fact that JRA is somewhat rare. Everyone has at least heard of diabetes and cancer, and even other diseases that are less common than JRA get a lot of publicity (Lupus, Parkinson's, etc.). With JRA and other lesser-known diseases, we have to explain ourselves to family and friends who want to know what's wrong with us. Explaining our condition is not so bad - I do like to spread awareness and generally respond to people with "I'm glad you asked!", followed by my launching into an explanation.

Complications arise when people have misconceptions about the disease, however. JRA and (the adult form) RA are NOT the same as the arthritis your 90-year-old grandmother has. No offense to grandma. I'm not knocking her condition. But what she has (more than likely) is osteoarthritis (OA), brought on by the wear-and-tear of joints from many years of use. OA is the most common form of arthritis and when elderly people suffer from stiff and painful joints, OA is usually what is behind it. Many medications, like Tylenol and Aleve, are a big help to these folks. Their pain is very real, but at the risk of repeating myself I have to emphasize that it is not the same as Rheumatoid Arthritis.

Actually, the word "arthritis" in the name is truly a misnomer, and many are calling for a name change that will reflect the disease's true characteristics. A friend of mine has suggested "RAID", to stand for "Rheumatoid Autoimmune Disease". I like it and I kinda hope it catches on! :D As long as "arthritis" is in the name, many people will confuse it with osteoarthritis. I can't tell you how many times I've heard people say "Oh, my grandma has that! You're way too young to have that!". I smile sweetly while in my mind I'm frustrated. I explain that autoimmune diseases do not discriminate - they attack people of all ages, genders and ethnicities. They attack organs, tissues, joints, blood vessels. They require lifelong treatments that can be very dangerous in and of themselves (more on that later).

Now for a real definition, finally: JRA and its adult cohort RA are autoimmune diseases characterized by inflammation of the synovial lining of multiple joints. Inflammation is the cause of those red and swollen joints I was describing in the previous post. What happens is that the body's immune system goes haywire. The same immune system that helps us fight off colds and infections gets confused. It starts attacking the lining of the joints, in this case, and sees it as a foreign object. Yep, you read that right: the body attacks itself! A very similar process occurs in other autoimmune diseases, in which an overactive immune system turns on the body and attacks healthy tissue and bodily organs. Heart, lungs, kidneys, you name it - there is an autoimmune disease for them all. One example is Type 1 diabetes, also known as autoimmune diabetes, which attacks healthy pancreas cells in children (so, so heartbreaking!!).

This is probably a good time for some perspective, and numbers help with that. RA affects approximately 1.3 million Americans (that's about 1% of the U.S. population), and I've already mentioned the 300,000 children with JRA (under the age of 18). The cause is unknown, but scientists have isolated genetic markers that are associated with RA. With this genetic predisposition, all that is needed is something to trigger the disease. Physical or emotional trauma can set the disease in motion, as well as a virus or bacteria. Even smoking can be a trigger (one more reason to quit, readers!). The idea is that the body's immune system starts to attack the virus, or the carcinogens from the cigarettes, or the body moves to correct an injury after a car accident...and after it's attacked the bad "stuff" (enough technical terminology going on here!) it just doesn't know when to stop. It turns on healthy "stuff" and the rest as they say is history. The Arthritis Foundation has a nice description on their website, if you're interested. Visit arthritis.org and click on 'who gets RA?".

What triggered my JRA at such a young age? I had choked on some carrots a few weeks before I first woke up with swollen knees. The doctors had to do an emergency broncoscopy on me - basically sucking all the little carrot pieces out of my throat and lungs - and we believe that this surgery was the physical trauma that set off the disease. Crazy, huh? To this day, whenever I feel myself start to choke on carrots, I can't help but smile. What's even crazier is that many with the genetic markers for RA never get it, and and not all people with RA have those genetic markers. Like I said, the cause is unknown and much more research needs to be done.

JRA: Juggling Radical Ailments

I'm not sure what a "normal" childhood is supposed to be, but I'm certain I didn't have one. And so much the better! Juggling radical ailments in addition to the minefields of a typical childhood made things interesting. I not only grew up much faster than my peers but also learned to appreciate the blessings in my life very early on - two wonderful parents, a happy home, a loyal dog, and an excellent education, among others.

My journey with JRA began when I was 18 months old and will follow me forever. I had been walking just fine at that age, when one morning I woke up with knees that were swollen, red, and painful. My mom tells me that I crawled into the kitchen, mostly using my arms, sobbing in pain. My knees were more than twice their normal size and it was clear that something was very wrong. You can imagine how this would make any mother feel, of course. Here was her only child, healthy and happy just yesterday, in agonizing pain that she couldn't eradicate.

Pediatricians weren't much help. They suspected that I had been abused, or was having a bizarre allergic reaction to something (even after negative allergy tests disproved this theory). My parents were determined to get a diagnosis for me, however, and would stop at nothing. It helped that both of them were in the medical field - my dad was a cardiologist and my mom an EKG technician - and so they knew the sooner I got care, the better.

The orthopedist did x-rays, an MRI, all that fun stuff, and quickly realized that I needed to see a rheumatologist...which was much easier said than done. There is a terrible shortage of pediatric rheumatologists in the U.S., and the waiting lists to see these specialists are ridiculously long. We waited a couple months, and that was a short time. In fact I think it would be easier to get 5 minutes with the President than with a pediatric rheumy as a new patient. (From here on out, by the way, I'll refer to my doctor as a rheumy. Makes for a nice abbreviation.)

By the time I saw this rheumy, my symptoms had gotten worse. Now the joints in my fingers and toes were red and swollen as well as my knees. Looking back, I realize it was a blessing in disguise - my symptoms looked very "textbook", and my blood tests matched them. Diagnosis: Juvenile Rheumatoid Arthritis, also known as JRA. The more specific diagnosis was Polyarticular Juvenile Rheumatoid Arthritis, to give you a real mouthful. This name was just fancy doctor-speak for "more than 5 joints affected".

Today, the disease is known as Juvenile Idiopathic Arthritis, or JIA. The distinction isn't all that significant, but it does make one aspect of the disease quite clear: there is no known cause. Lots of studies have been done to look for a definite cause, but the word "idiopathic" means that a cause cannot be pinned down. Some studies emphasize a genetic component, others an environmental one, and still others some combination of both. At any rate there is no definite cause and, more importantly, no cure for the 300,000 children in the country with JRA.

I promise I haven't fallen off the face of the Earth...

...I've just been very busy! :D I apologize for being such a terrible blogger to the point that it's been months since I've posted anything. I do have lots of ideas for upcoming posts, so not to worry. Check back in the coming days! :D