How difficult it must be for a patient with rheumatoid arthritis to make an intelligent decision about the best course of treatment to have, when there is a plethora of conflicting information concerning the drugs used to treat the disease.
One would be hard pressed to find a researcher who has not accepted funds for their research from the drug companies which produce these drugs, so exactly how unbiased the research is, one can only imagine.
There is much urgency expressed about the need to initiate therapy for the disease, before joint destruction occurs, however, it has been reported that in some instances, the disease progresses along with the disease modifying agents, DMARDs, used to treat it.
A study done with rheumatoid arthritis subjects in Japan between 1958 and 1966 found that rheumatoid arthritis was an “independent risk factor for mortality”. The study found that infections were associated with increased mortality rates in rheumatoid arthritis patients. Since disease modifying anti rheumatic drugs were unavailable when the study was done, they are unlikely to be a contributor to mortality.
What the researchers did find was that there was an increased amount of deaths from pneumonia and tuberculosis in rheumatoid arthritis patients, however, around the 50s and 60s tuberculosis was not uncommon in Japan, so it was not considered to be abnormal.
Liver disease was increased , and was considered to be a cause of mortality in the RA subjects, and since aspirin and indomethacin were commonly prescribed for the disease, these drugs were considered as possible causes of the liver disease. Cortisol-like drugs were used at the time of the study, they may have been associated with the increased infections.
A study 2007 at the Mayo Clinic :
” Researchers compared the survival rates of patients diagnosed with RA in 5 time periods: 1955-1964, 1965-1974, 1975-1984, 1985-1994, and 1995-2000 using Cox regression models, adjusting for age and sex. In the 5 time periods, there was no significant difference in survival rates for RA subjects—which also means no significant gains in longevity.”
“We found no evidence indicating that RA subjects experienced improvements in survival over the last 4-5 decades” states the study’s leading author, Dr. Sherine Gabriel. “In fact, RA subjects did not even experience the same improvements in survival as their peers without arthritis, resulting in a worsening of the relative mortality in more recent years, and a widening of the mortality gap between RA subjects and the general population throughout time.”
Ref: Arthritis & Rheumatism. 2007;56(11):3583-3587. ©2007 Wiley InterScience
Interesting to note that one can read many articles about how the new types of disease modifying agents, and anti-TNFs are the best drugs for controlling the progression of the disease, or as in some cases, and I quote from an article in Science Daily:
ScienceDaily (Jun. 20, 2007) — Early treatment with a combination of methotrexate and infliximab may be effective as remission induction therapy and alter the course of early rheumatoid arthritis (RA), according to data presented at EULAR 2007, the Annual European Congress of Rheumatology in Barcelona, Spain.
Methotrexate works partly by blocking the development of white blood cells in the bone marrow, and so patients may have excessive suppression of the bone marrow, with dangerously low levels of white blood cells, which could impair their ability to resist infections. In such a circumstance, even a mild infection such as a sore-throat could develop into a serious illness. Methotrexate may also reduce the production of platelets in the bone marrow, which help with blood clotting, patients may notice that they bruise very easily, or bleed spontaneously from the skin, gums, Methotrexate can damage the liver, and this may happen with very few outward signs This drug has numerous potential side effects
Infliximab may decrease your ability to fight infection and increase the risk that you will get a serious or life-threatening infection. If you experience any of the following symptoms during or shortly after your treatment with infliximab, call your doctor immediately: sore throat; cough; fever; extreme tiredness; flu-like symptoms; warm, red, or painful skin; or other signs of infection. Infliximab increases the risk that you will get some types of infections that are most common in certain parts of the United States and the world.
You may be infected with tuberculosis but not have any symptoms of the disease. In this case, infliximab may increase the risk that your infection will become more serious and you will develop symptoms.
It’s extremely difficult to see how early treatment with methotrexate and infliximab , in combination, could contribute to remission induction. Perhaps one could be forgiven if one assumed what was meant here was that the patient was healed, but that’s not what the report says, maybe the RA symptoms are no longer a bother, but at what cost to the general health of the patient?
There are many glowing reports from patients about how these drugs have improved their arthritis symptoms, there is no mention of all the other symptoms which may be now making their appearance, unrelated to their arthritis. A patient with RA who has had to endure incredible pain will naturally be very happy if the pain and the inflammatory response, is put to rest.
Will these patients associate their present infections they may be experiencing with their drug treatment ? It has been reported that the rate of overall serious infections experienced by patients taking anti-TNFs was higher than in those taking the DMARDs. What is meant by serious infections is those infections which have necessitated hospitalisation.
Reactivation of latent TB has been associated with anti-TNFs and other opportunistic infections, such as Listeria, histoplasmosis, and coccidiomycosis, have been reported in patients receiving TNF inhibitors, but their arthritis symptoms have been alleviated!
Probably the very best medicine for gout is a healthy diet, most first time gout attacks occur after an enjoyable time spent wining and dining, or too much beer drinking, or eating too much generally.
Apparently the frequency of gout is increasing in the US, and now almost 3 million people have gout, exactly why this is so is not particularly hard to work out . Gout has a definite connection to a faulty diet, sure, some people can blame their gout on their genes, however, inheriting a predisposition to gout does not necessarily mean that gout is inevitable for you.
Change your diet from a high protein intake to a low protein intake, say no 2 all saturated fat, all processed food, beer, sodas, both diet and otherwise, leave off the seafood, anchovies, and sardines, then begin a diet of fresh fruit and vegetables, and your gout will leave you alone.
Urtica urens more commonly known as nettle is a great remedy for gout, it has been reported that gouty patients treated with nettle pass large quantities of gravel, for it facilitates the passage of uric acid from the system. The urtica was usually taken in tincture form, 5 drops in a small glass of warm water.