 |
 |
 |
|
 |
|
|
|
|
 |
 |
Asia's New Epidemic
Diabetes is assailing tens of millions, and its victims are younger than ever
[01/21/2002] |
|
|
 Indicates premium content |
|
|
 |
|
 |
|
|
|
|
 |
|
|
E-mail your letter to the editor
|
|
|
|
|
|
|
|
 |
| Rheumatoid arthritis |
 |
|
|
|
|
The Other Crippling Joint Disease |
|
|
|
|
|
By David Bjerklie |
|
|
|
|
 |
|
|
|
Posted Monday, June 9, 2003; 22:50 HKT
As debilitating as osteoarthritis can be, it at least develops gradually. That may not seem like much consolation until you consider the other arthritis—rheumatoid arthritis (RA)—which in severe cases hits like a freight train. "People who are jogging one day," says Dr. Stanley Cohen of Dallas' St. Paul Medical Center, "can't get out of bed two weeks later."
Although the symptoms can be similar, the diseases are very different. Osteoarthritis is focused on a particular joint; RA is a systemic disease—an autoimmune disorder in which the body's defense system attacks the joints through the thin layer of cells called the synovium that line and lubricate the joints. The runaway immune response clogs the synovium with infection-fighting cells that release proteins called cytokines. These are compounds that fuel inflammation. The synovium becomes engorged with new blood vessels and begins to grow, kudzu-like, penetrating and further damaging cartilage and bone.
The most visible symptoms of RA are swollen joints and crippling stiffness, particularly of the hands and feet. It can cause fatigue, fever and loss of appetite. It can also affect the heart and lungs and their surrounding membranes. The disease, which afflicts 2.5 million people in the U.S., usually hits between ages 30 and 50, but it can strike at any age, including childhood. It is three times as common in women as in men and can shorten life by a decade.
When RA was given its name in the 19th century, those who suffered from it—including impressionist master Pierre-Auguste Renoir—had little to look forward to beyond life in a wheelchair. Even in the 1950s, says Cohen, few treatments were available other than aspirin or cortisone, a powerful anti-inflammatory with severe side effects when used at high dosages. Injections of gold salts also provided some relief, although no one really knew why.
Prospects have improved dramatically—especially, says Cohen, "if we treat early and we treat aggressively." Dr. Anand Malaviya, India's foremost expert on the disease, warns that in Asia this is a complicated order. In India alone, he says, there are some 10 million people with RA. Roughly 70,000 specialists would be needed to treat them all; India has between 50 and 100. "The shortfall is staggering" and the consequences of misdiagnosis severe. "Giving patients some sort of alternative herbal cure or therapy, or even magic, can be disastrous. It can kill a patient," Malaviya adds.
Today the most effective treatments are combination therapies. Methotrexate, a cancer drug that has been used to treat RA for 30 years, is augmented by other drugs, including the new but costly "biologics" such as etanercept (Enbrel), infliximab (Remicade) or anakinra (Kineret). These are genetically engineered versions of naturally occurring molecules that bind or block the activity of cytokines. Also in early development are drugs designed to reduce the formation of the blood vessels that feed the growth of the synovium.
Researchers have discovered a genetic marker that is often associated with RA's earliest onset and most severe cases. Yet not all RA sufferers have the marker (and vice versa), which makes scientists wonder whether RA is a single disease. Environmental factors might also play a role, although no one knows whether the trigger is a virus, a bacterium or something else. Autoimmune diseases are always tricky. But even if RA doesn't yield to a simple fix, it is becoming easier to manage for those who can get proper treatment.
|
|
