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Doctor's Diagnosis: Rheumatoid arthritis

Several years ago my friend Lynne developed increasing difficulty using her hands. This was particularly alarming to her since she relies on them to perform her job as a nurse anesthetist. After some uncertainty, she was eventually diagnosed with rheumatoid arthritis.

“Arthritis” is a general term meaning inflammation of the joints without specifying the cause. Lupus, gout, Lyme disease, even psoriasis can all cause arthritis.

Rheumatoid arthritis is a very specific disease. It is an autoimmune disease, where — for unknown reasons — the immune system attacks and destroys healthy tissue. In this case, the linings of various joints are the targets. Like many autoimmune diseases, rheumatoid arthritis most often affects middle-aged females.

Frequently the hands are involved resulting in very characteristic deformities, such as painful swollen knuckles and fingers deviating to the pinky side. Other joints such as the elbows, knees, ankles and hips are also frequently involved. When advanced, the arthritis can become totally disabling.

Rheumatoid arthritis does not just affect the joints. Patients often develop fatigue and fever. Skin nodules, anemia, heart disease, lung disease and even eye problems are often present.

There is no cure for rheumatoid arthritis, and managing the disease is more art than science; there is no simple protocol to follow.

The disease is treated aggressively as soon as the diagnosis is made, hopefully before there is any permanent damage to the joints. Nonsteroidal medicines and steroids play a role but more potent “disease-modifying” agents are usually needed.

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A new class of drugs has been introduced in the past few years, the so-called "biologic" agents. Modern biotechnology has designed these drugs specifically to alter the body's immune system. Though often extremely effective, they are not without problems. They are very expensive, often must be given by injection, and also make the patient vulnerable to serious infections.

Surgery is often required to replace or repair joints and tendons. Occupational and physical therapists can be helpful in maximizing the patient’s activities by providing exercises, offering heat and cold therapies, and providing aids such as splints. Assistive devices are available to help with tasks — such as opening jars and using knives — that may be very challenging in patients with advanced disease.

My friend Lynne continues to struggle with her rheumatoid arthritis but thanks to one of the newer medications is still able to work. In spite of her arthritis, her patients are in good hands.


Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at health@newsday.com.

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