Health hotline: Aggressive treatment helps arthritis

For destructive power, rheumatoid arthritis has few peers.

"If it goes on untreated for even a year or two, it can already produce a lot of destruction in the joints, including damage to bone and cartilage, leading to pain and loss of mobility," said rheumatologist Dr. Don Stromquist.

But treatment of the disease has improved vastly in recent years. "In many cases, we can almost put a halt to the disease with drug treatment," he said. That's not true of the more common osteoarthritis, which results from injury and wear and tear.

"Even though we don't understand the cause of rheumatoid arthritis," which can affect people of all ages, said Stromquist, "research has understood the way inflammation works and several drugs have been developed that can slow down or sometimes stop the inflammatory process."

Arthritis is the subject of today's Deseret Morning News/Intermountain Health Hotline. From 10 a.m. to noon, Stromquist and Dr. Sean McMillan will take calls and answer questions about the disease and related chronic painful conditions.

The first drug approved specifically for rheumatoid arthritis, back in 1985, was methotrexate, a drug developed as a cancer chemotherapy that in very low doses can help bring RA under control. It's a management tool, not a cure.

Another category of drugs, called biologic drugs, are protein molecules that are injected. They're similar to medications used for multiple sclerosis, cancer and other diseases and have been engineered to "lock onto inflammatory substances in your body and soak them up," he said.

"These biologic drugs are a tremendous step forward. They can improve arthritis to a great degree in many people. For some, they slow it way down, while in others they stop it altogether. Even for those with a lot of damage, they often feel better when they're treated aggressively," said Stromquist.

Exercise is also a key component of conquering arthritis, including rheumatoid. The drug treatments make it possible for people with even severe rheumatoid arthritis to exercise, which helps them regain lost strength. "Many joints gain a lot of support through muscle power and the strain is taken off the joints," he said.

"I spent my days begging patients to get moving and exercise. But you can overdo." He sends patients to a physical therapist to learn how to exercise safely and tailor it to their needs.

With RA, seeking treatment sooner is better, the two doctors agree. Symptoms include widespread joint pain, often with swollen joints. Many people with RA feel very stiff in the morning when they get up.

RA has a "slight preference" for women over men and it can also afflict children.

Some things don't seem to impact the disease much, including food, he said. "There's little in the diet that honestly makes the difference. Smoking is bad for rheumatoid arthritis. Excess weight is a huge issue."

The good news is how effective treatment can be, McMillan added. "We don't see people in wheelchairs anymore because of rheumatoid arthritis," he said. "That's almost unheard of."

Once the diagnosis is confirmed, the doctors said they prescribe a relatively aggressive drug treatment regimen. And if they don't get results, they may "turn it up" in a few months.

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E-mail: lois@desnews.com