Life With Rheumatoid Arthritis

Aggressive treatment with new, sophisticated drugs can prevent disability.

Medically Reviewed by Brunilda Nazario, MD on January 05, 2010

Carla Guillory was in her 30s -- enjoying life, raising her kids -- when the first symptoms began. "We'd been hiking on vacation, and I thought I had bruised my foot, but it didn't seem to get better. Then my hands started aching," she remembers.

Right away, doctors suspected she had rheumatoid arthritis. Guillory was tenacious about finding the right doctor -- one who would treat her aggressively. She knew she had to tackle this thing head-on, she says. And that she did -- with disease-modifying drugs that helped curb the damaging inflammation at her joints.

That aggressive treatment, and getting it early, has made all the difference, says Guillory. "I have some deformity in my hands, but not a whole lot. It's nothing like other people I've met."

Twenty years ago, the picture for most patients was very different. "A person in the fairly young part of life would get this disease, and within five years they would be deformed and disabled. About half the people with RA had to quit working within 10 years," says Stephen Lindsey, MD, chairman of rheumatology at the Ochsner Clinical Foundation in Baton Rouge, La.

More than two million Americans suffer from rheumatoid arthritis, also known as RA. About 75% of them are women, according to the American College of Rheumatology. While RA can develop at any age, it often begins between ages 30 and 50. Pain, stiffness, swelling, and limited motion and function of joints -- especially hand and foot joints -- are the primary symptoms.

Today, doctors are better able better to diagnose the disease, determine how advanced it is - and how best to treat it, says Lindsey. New research has revealed more about the disease itself.

Rheumatoid arthritis is an autoimmune disease, which means that the body mistakenly identifies certain cells as foreign and attacks them -- triggering the inflammation that damages healthy joints. Exactly what sparks this malfunction remains unclear, but research has led to important new treatments.

Some remarkable drugs have emerged to specifically short-circuit the immune system malfunction, says Lindsey, who has treated Guillory for the past eight years. "The last decade's been amazing. It used to be that we could treat the pain but not the disability. That's dramatically different now. The key is early diagnosis, then aggressive treatment with the right medicine."

To protect joints from damage, doctors turn to disease-modifying antirheumatic drugs (DMARDs). These include several drugs used in the 1960s and 1970s to treat other diseases -- and were discovered to also work with rheumatoid arthritis.

For example, methotrexate, a drug that Guillory took early on, was first used as a form of cancer chemotherapy. It's still considered an important medication for slowing RA, although it is prescribed at lower doses than used for cancer treatment, Lindsey explains. "The side effects are more acceptable for methotrexate than with other cancer drugs," he tells WebMD.

Today, DMARDs are prescribed earlier in treatment than ever before, Lindsey says. "The most joint damage and deformity occurs in the first two years and will progress over time, leading to disability. We can prevent that joint damage."

A newer class of drugs -- biological response modifiers, or biologics -- is generating the most excitement. Evidence shows that biologics can actually halt the disease when used early on, he tells WebMD. "Instead of seeing the progressive deterioration and disability, we can now stop disease progression." Biologics approved by the FDA include Actemra, Cimzia, Enbrel, Humira, Kineret, Orencia, Remicade, Rituxan, and Simponi.

Very often, patients are switched to different drugs -- and often take multiple drugs -- during the course of treatment, he points out. "Each patient is different, so we have to follow them really carefully, every month. If they don't improve, we quickly move to a different drug."

Guillory now takes a biologic drug to better control her disease. And it has, she reports. It's also made a huge difference in her quality of life, she tells WebMD. "Before I started taking it, I would be exhausted by midday, ready for a nap. Now I don't have as many days that I'm tired. It's made a tremendous difference."

After coping with rheumatoid arthritis for nearly 20 years, Guillory offers these words of wisdom: "Try to be careful in your everyday activities. Don't do anything that will damage your joints. Take medications as you're supposed to. Also, take things day by day. Hold on to positive thoughts."

Indeed, honing your coping skills is important, Lindsey says. "Having a good attitude, taking care of yourself, taking the medicines, getting regular exercise, volunteering to help other people with the disease -- all those things help you feel better about yourself, and that helps you cope."

He advises patients to take advantage of Arthritis Foundation programs, including water therapy classes and educational programs (to learn more about their disease). "You'll get to know others who are dealing with the same disease. You'll learn about volunteer opportunities. Those things take your mind off yourself, which always makes you feel better."

Show Sources

SOURCES: American College of Rheumatology. Carla Guillory, rheumatoid arthritis patient. Stephen Lindsey, MD, chairman of rheumatology, Ochsner Clinical Foundation, Baton Rouge, La. News release, FDA.

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