Progress Noted in Rheumatoid Arthritis Battle
Every few months, the medical journals report another promising treatment for rheumatoid arthritis: cancer drugs, radiation, interferon, estrogen, transplant medicines, blood purification, fish oil and more.
Why? Because no one knows what causes rheumatoid arthritis. No single therapy works for every victim. There is no cure.
The best doctors can hope is to quell the pain and, perhaps, to slow the destruction of the body’s joints.
Yet experts say several innovations, including more effective drugs, have helped them to improve the lives of this country’s 7 million victims.
“In the last 10 years, the kind of hopeless, crippling, relentless course of this disease that used to depress us has lifted significantly,” Dr. Gerald Weissmann of New York University says. “The modern rheumatologist handles his patients so much better than when I was going to medical school, and I think there’s been a real change in the way that rheumatoid arthritics look and act.”
‘Rheumatoid Derelicts’ Rare
Now, he says, physicians rarely see “rheumatoid derelicts”--people bent, bedridden and ruined by their illness.
The drugs relieve inflammation. They help people walk, climb stairs and live in relative comfort. But they will not make the disease go away.
“They are all treatments. Until the cause of this disease is known, we’ll be dealing with treatments, not cures,” Dr. John H. Klippel of the National Institutes of Health says.
But on the horizon is a glimmer of understanding of this cause. Steadily, biologists are zeroing in on an apparent genetic defect that somehow makes people susceptible to the disease. With this, someday, may even come a vaccine to prevent it.
Arthritis is really many diseases, perhaps 100 or more. By far the most common is osteoarthritis, the aches and pains that are an inevitable part of aging. An estimated 16 million Americans have this condition, which results from wear and tear on the joints.
Far more serious, however, is rheumatoid arthritis. For reasons that no one understands, the immune systems of victims launch ruinous attacks on their joints. The synovial membrane, the velvety tissue that lines the capsule around the joint, becomes inflamed. Eventually, cartilage and bone are eaten away, and movement is painful.
The basic weapon against rheumatoid arthritis is aspirin. However, some people cannot tolerate large doses of this medicine because it may cause upset stomachs or digestive bleeding. So they take other drugs, such as Clinoril and Motrin, that are known generally as non-steroidal anti-inflammatory agents.
Many non-prescription drugs that are touted for relief of arthritis contain aspirin as their main ingredient. Acetaminophen, another common over-the-counter pain reliever, is not a good substitute because it does not relieve inflammation.
When aspirin-like drugs are not enough, doctors move on to more powerful medicines. These include gold salts, which recently became available in pill form, and penicillamine. However, these drugs can cause serious side effects and people often must stop using them.
For about two years, many specialists have been prescribing low doses of a cancer chemotherapy drug called methotrexate to suppress inflammation.
Cancer Drugs Promising
“It will clearly help a substantial number of patients who have not experienced a remission and are not adequately managed on a non-steroidal alone,” Dr. K. Frank Austen of Harvard Medical School says.
Another potential cancer treatment, the hormone gamma interferon, also shows promise in early testing against arthritis. However, cancer is not the only disease from which drugs are being borrowed. Researchers are also experimenting with Azulfidine, a medicine for ulcerative colitis, and cyclosporine, which prevents rejection of transplanted organs. Even thalidomide, the sedative that caused severe birth defects, has been suggested as a possible therapy.
While some researchers scour the drug shelves for possible treatments, others delve into the body’s genetic blueprint to find out what causes arthritis. They have identified a cluster of genes that seems to be far more common among arthritis victims than among healthy people.
Trigger Suspected
One popular theory holds that people with a particular group of genes are susceptible to rheumatoid arthritis. But some trigger, such as a virus, sets off the destructive process.
“I think it’s a very common virus,” Dr. Frederic C. McDuffie of the Arthritis Foundation says. “Maybe everybody’s got it. Unless you have a certain pattern of DNA, it doesn’t bother you. But if you have the wrong gene, it produces arthritis.”
If the genetic culprit can be found, then it should be possible to test people for the rheumatoid arthritis genes and identify those who have them before they get sick. And if the virus that touches off arthritis could be tracked down, the next step might be the development of a vaccine to protect these susceptible people from the germ and the disease.
“If somebody had said this to me 10 years ago, I’d have said it sounds like Mickey Mouse science fiction,” Weissmann says. “I don’t think it’s science fiction anymore.”
Last year, the public donated $39.6 million to the Arthritis Foundation to fight rheumatoid arthritis and other arthritic diseases. The National Institutes of Health spent $111.3 million on arthritis research.
