Rheumatology Center of Princeton, 3100 Princeton Pike Building 3, Suite D Lawerenceville 08648 Phone Number: 609-896-2505

Preventative Treatments

Calcium

Your diet can affect the health of your bones. Calcium, in particular, is important and essential to bone health as a way of stopping bone loss and rebuilding bones. Good sources of calcium include milk, yogurt, cheese, fish, and vegetables. Adequate levels of Vitamin D are required to absorb calcium from the diet or calcium supplements.

Exercise

Weight-beating exercise is also important to bone health. Other ways of keeping your bones strong include low-impact aerobics, walking, running, tennis, strength training, dancing, and gardening.

New Treatments for Rheumatoid Arthritis

For people suffering from rheumatoid arthritis (RA) – a debilitating form of arthritis that affects 2.1 million Americans – groundbreaking new therapies are changing the course of treatment and offer new hope for pain relief and the potential for joint healing.

RA is a chronic autoimmune disease that causes painful inflammation in the lining, or synovium, of the joints. This inflammation, if left unchecked, can cause damage to the cartilage and bone loss, resulting in deformity, chronic pain, loss of function and ultimately in disability.

Typically, a serious and debilitating condition, RA is a crippling form of chronic arthritis that attacks multiple joints and is frequently bilateral. This means it affects the joints on both sides of the body similarly, particularly the middle finger joints, base of the fingers, wrists, elbows, knees, ankles and feet. It nearly always involves the wrists and middle and large knuckles, but seldom the joints nearest the fingertips. Morning stiffness that lasts for an hour or longer – a hallmark of the disease – is often used to help diagnose RA and gauge the severity of inflammation. Other symptoms associated with rheumatoid art hritis include depression, fatigue, low-grade fevers and malaise.

In addition to attacking the joints, rheumatoid arthritis is systemic. It can involve other organs, including the skin, eyes, lungs and heart. Systemic complications of RA are similar to those of severe heart disease, advanced Hodgkin’s lymphoma and other chronic debilitating and life-threatening diseases.

While the impact of hormonal factors on RA continues to be studied, current studies show that women are up to three times more likely to suffer from the condition. The disease can affect people of all ages, but typically strikes those between 30 and 60 years of age. Women with RA often experience relief during pregnancy with a significant increase in symptoms after childbirth.

While the cause of rheumatoid arthritis remains unclear, it is classified as an autoimmune disease – a disease in which the body’s own immune system goes awry and attacks itself.

Research has yet to determine the role of genetics in rheumatoid arthritis. However, people with a family history of autoimmune diseases such as lupus, multiple sclerosis, Graves disease and scleroderma, tend to have an increased risk of developing other autoimmune diseases, such as RA.

Whether it is the result of a genetic, environmental or hormonal factor – or a combination of factors, something triggers the immune system to go on the offensive. Once the immune system has been triggered, white blood cells travel to the joints and attack the connective tissue known as the synovium, causing inflammation characterized by warmth, redness, swelling and pain in the joints – typical symptoms of rheumatoid arthritis. This inflammation of the joints makes the normally thin synovium become thick and grainy, causing the joint to swell. As RA progresses, the thickening synovium invades and destroys the cartilage within the joint and eventually erodes the bone, causing permanent bone loss and debilitating loss of mo tion.

While rheumatoid arthritis is recognized as one of the most crippling diseases, recent breakthroughs in the availability of medications and groundbreaking new therapies have marked a crucial turning point in the treatment and prognosis of RA patients.

At one time, treatment for RA involved a ‘pyramid approach,’ beginning with the least aggressive form of treatment and holding off on stronger therapies and medication until evidence of bone loss and deterioration was discovered. Today, doctors advocate for earlier diagnosis and a more aggressive front line approach to treatment using advanced new drug therapies and treatments to reduce the pain and inflammation of RA and its resulting debilitating effects in a more targeted manner.

In addition to anti-inflammatory drugs and oral steroids, disease modifying, anti-rheumatic drugs (DMARDs) are typically used to treat patients. These drugs are designed to interrupt the disease process by effectively shutting down the function of the immune system. Methotrexate is one of the most commonly used DMARDs and a mainstay in RA drug therapy.

Promising new advances in RA treatment involve a new group of anti-inflammatory medications called biologic response modifiers, including Enbrel, Humira, Kineret and Remicade. These drugs specifically target parts of the immune system and block proteins that play a key role in the development of inflammation and joint damage and are highly effective. In addition, because they don’t shut the immunesystem down completely, they may have fewer side effects. “Biologics” are often used in combination with Methotrexate, and have been successful in reducing bone destruction – and in some cases, may heal erosions to the bone tissue.

Another promising new medication for RA patients – particularly those who have not been helped by other treatments – is abatacept (marketed as Orencia), which recently received FDA approval and will be available for patients in February 2006. Abatacept is part of a new class of medications known as co-stimulation modulators that block specific cells within the immune system, which cause inflammation. In clinical trials, abatacept more than doubled the rate of symptom improvement for those with difficult-to-treat rheumatoid arthritis.

Also on the horizon are new applications for drugs already approved and in use for other conditions. Rituxan, currently used to treat cancers of the lymph nodes, has shown great promise targeting immune response in rheumatoid arthritis treatment.

Dr. Gina Del Giudice, M.D., FACR, FACP
Rheumatologist, University Medical Center at Princeton
Website designed and hosted by Princeton Online