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Senior Citizen Health & Medicine
Aging Gracefully with the Chronic Disease –
Rheumatoid Arthritis
As rheumatoid arthritis patients grow older, they
face new challenges of managing the incurable condition: UM Health
Minute with video
May 15, 2007 - For the better part of three
decades, Sherrie Kossoudji has endeavored each day to manage the
inflammation, chronic pain, tight joints and other types of physical
strife caused by rheumatoid arthritis. The University of Michigan Health
Minute looks at her life and seven key facts about the disease.
“Rheumatoid arthritis affects my life in as many
ways as you could possibly imagine, and pretty much at all times,” says
Kossoudji. “It is a disease that can be manipulated with medicine, but
it doesn’t ever really go away.”
Now 53, Kossoudji is dealing with a new aspect of
her chronic disease: sorting out what is a normal part of aging, and
what is a facet of rheumatoid arthritis, or RA. If she has a sore leg, a
pain in her elbow or a kink in her wrist, is it because of RA or is
there another cause?
“I have fingers that don’t work well, joints that
don’t work well. I have a wrist that doesn’t flex and neuropathies in my
legs,” she says. “I think it’s difficult when someone has a long-term
disease to separate what happens as the body ages from what happens when
you have a disease for a very long time.”
RA is debilitating for some patients as they age,
so it is especially important for people with RA to see a rheumatologist
to determine the best course of treatment and to gain the best possible
understanding of what is happening in one’s body, says David A. Fox,
M.D., division chief and professor of rheumatology at the University of
Michigan Health System. Fox is Kossoudji’s rheumatologist.
Whatever the age of the patient’s RA onset –
whether it is at a young age, like Kossoudji at the time of her
diagnosis, or later in life – Fox emphasizes that RA is not a normal
part of aging. It is a specific condition with symptoms that can’t be
cured, but can be managed.
“Arthritis should not be considered just a part of
the aging process or a normal part of getting older,” Fox says. “There
are some elderly people who don’t have arthritis, and many people who
develop arthritis when they are younger.”
Many patients are helped by some of the available
treatments, including pain relievers and anti-inflammatory medications
known as nonsteroidal anti-inflammatory drugs (NSAIDs) and
disease-modifying antirheumatic drugs, such as methotrexate and tumor
necrosis factor (TNF) blockers. Exercise, weight loss and diet changes
also can be helpful, Fox says.
RA is one of more than 100 varieties of arthritis,
a wide-ranging set of conditions that affects 70 million people in the
United States. RA involves a malfunctioning of the immune system that
causes inflammation in the lining of the joints. With time, the
cartilage and bone are attacked and invaded, Fox says, to the point that
the structure of the joint can be destroyed. This can lead to
deformities and disabilities.
“Patients may develop inflammation in their lungs
or peripheral nerves, inflammation in the salivary glands or tear glands
that prevent them from functioning normally, and they may become what we
call ‘systemically ill’ – that is, the disease can affect the patient’s
body as a whole,” he says.
One very important thing that Fox tells his
patients with RA is that they do not have to stop living their lives.
Kossoudji, for one, has followed the advice. “My job is to make sure
that rheumatoid arthritis diminishes my life as little as possible,” she
says. “My goal is not to overcome the disease, but to do my best at
managing the disease.”
Seven key
facts about rheumatoid arthritis
● What
it is: Rheumatoid arthritis (RA) is a disease that
causes pain, stiffness, swelling and loss of motion in the joints. It
occurs most commonly in the fingers, wrists, elbows, shoulders, jaw,
hips, knees and toes. RA often appears first in early adulthood or
middle age, but sometimes does not occur until the later years.
(Osteoarthritis is another common type of arthritis; it causes a
breakdown of the cartilage in the joints.)
●
Symptoms: Symptoms include joint pain and stiffness,
particularly in the morning; red, warm or swollen joints; deformity of
the joints; mild fever; fatigue; loss of appetite; anemia; and small
lumps or nodules under the skin. Symptoms can be present nearly every
day, or they can come and go.
●
Diagnosis: Your health care provider will review your
medical history and examine you. He or she may order blood tests and
x-rays to confirm the diagnosis and measure the extent of the disease.
●
Prevention: The best ways to try to prevent arthritis,
Fox says, are maintaining a good body weight and not smoking. To try to
prevent osteoarthritis, he also advises that you use common sense when
engaging in strenuous physical activity so you don’t seriously injure
your joints.
● Who is
at risk: RA can affect people of different ages, races
and sexes; it is three times more common in women than men. Genetics can
affect a person’s chance of developing RA, but if one of your parents
had the condition, it does not necessarily mean that you will. Being
overweight is a major risk factor for osteoarthritis, and recent studies
have shown that smokers may have twice the chance of developing RA as
non-smokers.
●
Treatment: RA can be managed but not cured. The goal of
treatment is to keep the joints working properly by reducing
inflammation, relieving the pain and stiffness, and stopping or slowing
down joint damage. Many drugs are used for the long-term relief of
rheumatoid arthritis. One type is nonsteroidal anti-inflammatory drugs
(NSAIDs) that treat pain and inflammation (aspirin, ibuprofen and
naproxen are NSAIDs that are available without a prescription, and
others are available by prescription only). When NSAIDs do not work,
disease-modifying antirheumatic drugs (DMARDs) may be used, with careful
supervision by a rheumatologist. Methotrexate and tumor necrosis factor
(TNF) blockers are examples of DMARD that have been found to be helpful
for many RA patients. Injections, physical therapy and surgery are other
potential treatments.
●
Possible treatment in the future: Ongoing research
offers significant hope that in the future, cures will be available for
RA, Fox says.
For more
information, visit these Web sites:
U-M Health Topics A-Z
National Institute of Arthritis and
Musculoskeletal and Skin Diseases
Arthritis Foundation
American College of Rheumatology
Original
report written by
Katie Gazella
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