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Top Docs: 5 things to know about arthritis

Arthritis isn't just an illness of older people. There are dozens of kinds of arthritis, and some can strike as early as childhood.

Whatever the case, the joint inflammation caused by arthritis can be painful and debilitating. But new medications are making a difference for many people, and more may be on the way. Here's what you need to know:


1. 'BIOLOGIC' DRUGS HELP TREAT RHEUMATOID ARTHRITIS

Many types of arthritis develop when the body's immune system goes out of whack, said Dr. Mark Tan, a Smithtown rheumatologist who's affiliated with St. Catherine of Siena Medical Center. In rheumatoid arthritis, for example, an overactive immune system turns on the body and attacks the joints.

In recent years, scientists have developed so-called "biologic agents" that interfere with communication within the immune system. This can "change a patient's immune system to slow down its attack on the joints and body," Tan said.

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Newer biologic drugs -- such as so-called TNF blockers (infliximab and etanercept) and B-cell modifiers (rituximab) -- "are much more effective than the old medications," Tan noted.


2. THEY CAN CAUSE SERIOUS SIDE EFFECTS

The good news is that "biologics are really the wonder drugs of the last 15 years," said Dr. Louis Tiger, a rheumatologist based in Massapequa. "A great number of studies show they actually slow down the progression of the disease."

However, Tan added, there are risks. "The newer biologic treatments modulate and change the body's immune system, and thus might increase the risk for certain infections, or in some cases, lymphoma, he said. "Allergic reactions have also been reported, but the patients are usually given medications at the time of infusion to prevent this."

Tan said patients should seriously consider the risk of complications like lymphoma, a form of cancer. "It is a personal decision between the patient, family and the treating rheumatologist as to whether the benefits of taking these new immune-modulating medicines outweigh those possible risks," he said.

However, he said, it's important for patients to understand that these drugs don't kill the immune system but rather adjust it. Sometimes, Tan said, people misunderstand and think the immune system will be wiped out.

Tiger said that doctors and patients have to be vigilant about the possibility of infections. The risk for cancer, he noted, appears to be very low.


3. LIQUID GELS CAN DELAY SURGERY

The most common type of arthritis, osteoarthritis, occurs because of a breakdown of cartilage in the joints, which normally provides cushioning. Wear and tear is the usual culprit, Tan explained. Doctors are now injecting arthritic knees and shoulders with liquid gels that are similar to cartilage, he said.

"This has been shown to be as effective, in most instances, as minor surgeries such as arthroscopic surgery," Tan said. "And it can put off the need for a knee replacement."

Tiger said that the treatments, known as hyaluronic acid injections, rarely have serious side effects and don't cause the stomach problems that painkillers, another treatment option, can.


4. SUPPLEMENTS MIGHT HELP

Arthritis sufferers sometimes take over-the-counter supplements such as glucosamine and chondroitin, and "many people find great relief from them," Tiger said. Scientific proof, though, is lacking. The nutrients are normal components of cartilage, but studies to date haven't produced proof that taking them as supplements stems the pain of osteoarthritis, according to the U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Glucosamine is "likely effective" as a treatment for osteoarthritis, but not in all cases, reports the U.S. National Library of Medicine. And it may take weeks longer to relieve knee pain with glucosamine than with painkillers like ibuprofen (Motrin or Advil, for instance).

It describes chondroitin as a "possibly effective" treatment for osteoarthritis, yielding pain relief that's moderate at best.


5. THE FUTURE MAY BRING NEW TREATMENT DIRECTIONS

When it comes to rheumatoid arthritis, scientists are developing new biologic treatments that may be better able to treat specific types of arthritis, Tan said.

Tiger said that the ideal medication for arthritis would have no side effects and put people in remission for good. But is that possible?

"When I started doing this many years ago, who would have dreamed of the biologics?" he said in noting the progress that arthritis treatment has made. "Now, we've taken people who couldn't work, couldn't take care of their household, and gotten them back to being productive."

Research on the osteoarthritis front, Tan said, is focusing on replacing joint fluid and developing new anti-inflammatory painkillers that will not only reduce inflammation but also adjust the immune system.

According to Tiger, there's long been debate over how much an overactive immune system has to do with osteoarthritis. Researchers have been trying to understand how inflammation -- the immune system's response to injury -- is connected to osteoarthritis. They're exploring whether it might play a role in its development in the first place or worsen it and contribute to its progression.


Rheumatologists

Dr. Elise Belilos

Winthrop University Hospital

Div. Rheumatology & Allergy

120 Mineola Blvd., Ste. 410

Mineola

516-663-2097

Dr. Sheldon P. Blau

566 Broadway

Massapequa

516-541-6262

Dr. Steven Carsons

Winthrop University Hospital

Div. Rheumatology & Allergy

120 Mineola Blvd., Ste. 410

Mineola

516-663-2097

Dr. Daniel H. Cohen

1157 Broadway

Hewlett

516-295-4481

Dr. Richard A. Furie

2800 Marcus Ave.

Ste. 200

Lake Success

516-708-2550

Dr. Robert Greenwald

2 ProHealth Plaza

2 Ohio Dr.

Lake Success

516-622-6090

Dr. Max Hamburger

1895 Walt Whitman Rd.

Melville

631-249-9525

Dr. Michael L. Hoffman

560 Northern Blvd.

Ste. 107

Great Neck

516-498-3500

Dr. Alan T. Kaell

315 Middle Country Rd.

Ste. 6

Smithtown

631-360-7778

Dr. Esther Lipstein-Kresch

2 ProHealth Plaza

2 Ohio Dr.

Lake Success

516-622-6090

Dr. Gary Meredith

2 ProHealth Plaza

2 Ohio Dr.

Ste. 200

Lake Success

516-622-6125

Dr. Andrew J. Porges

1044 Northern Blvd.

Ste. 104

Roslyn

516-484-6880

Dr. Michael Repice

5 E. Main St.

Huntington

631-271-1640

Dr. James M. Sullivan

711 Stewart Ave.

Garden City

516-222-8654

Dr. Mark Tan

222 Middle Country Rd.

Fl. 3, Ste. 312

Smithtown

631-724-8900

Dr. Louis Tiger

566 Broadway

Massapequa

516-541-6262


How they were picked

Castle Connolly Medical Ltd. is a health-care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and top hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of top doctors and the medical leadership of leading hospitals.

Castle Connolly's physician-led team of researchers follows a rigorous screening process to select top doctors on both the national and regional levels. Its online nominations process -- located at castleconnolly.com/ nominations -- is open to all licensed physicians in America who are able to nominate physicians in any medical specialty and in any part of the country, as well as indicate whether the nominated physician is, in their opinion, among the best in their region in their medical specialty or among the best in the nation in their medical specialty.

Careful screening of doctors' educational and professional experience is essential before final selection is made among those physicians most highly regarded by their peers. The result -- Castle Connolly identifies the top doctors in America and provides the consumer with detailed information about their education, training and special expertise in their paperback guides, national and regional magazine "Top Doctors" features and online directories. Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors. (Newsday is not part of the selection process.)


To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.

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