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Joint Pain Forum – News you can use!

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Biologics to the rescue for Arthritis sufferers?


Biologics is a breakthrough treatment for rheumatoid arthritis but it is costly, writes M. Kaur

FIVE years ago, Professor Narehan Hassan woke up one morning with swollen joints — in her knees and wrists. This was the beginning of her journey that would lead to a diagnosis of rheumatoid arthritis (RA).

“The pain in my joints soon became excruciating. I couldn’t perform even routine tasks such as turning a doorknob or yawning,” she remembers.“Initially, I thought it was just a normal pain that would go off after one or two painkiller tablets but the pain progressed; it was soon present at any position, including sitting still. Even sleeping became painful.”

At that time, Narehan (now a university professor in the Klang Valley) was in the midst of completing her doctoral degree in the United States. Her fears turned into a nightmare when she woke up one winter morning and was unable to move anything, not even her fingers, due to intense pain.

“I waited and prayed for hours in bed, and when I finally found the courage to get up, I got dressed (three hours or so to take a shower and get dressed!) and went to see my doctor. After some blood tests and a few X-rays, I was informed that I had active RA.”

Things went downhill from there. The disease drastically affected her daily life — her work, social life, leisure activities and mental outlook. Everyday, she needed help from her younger sister to brush her teeth, shower and get dressed.

“I became depressed because I didn’t know how to handle the disease,” she says. “I tried non-steroidal anti-rheumatoid drugs (NSAIDs) but that didn’t help me — I was still in severe pain. I tried steroids, which helped with the pain, but they had side-effects. My body showed minimal progress with other medications.”

Narehan’s turning point only came in June 2004, when her doctor recommended that she try etanercept, a form of biologics treatment. She experienced relief from the pain almost immediately.

“I was shocked,” she laughs. “I could feel no pain. That day I actually took a shower on my own and then took my family to Klang for seafood.”

Consultant rheumatologist Dr Chow Sook Khuan, president of the Arthritis Foundation Malaysia (AFM), says that biologics is indeed a breakthrough treatment in treating RA and other forms of inflammatory arthritis such as ankylosing spondylitis and psoriatic arthritis — especially for those people who do not respond to NSAIDS — like Narehan.

“Biologics are drugs derived from living organisms and are designed to either inhibit or supplement a specific component of the immune system called cytokines. These cytokines play a pivotal role in either fuelling or suppressing inflammation (a key component in several forms of arthritis such as rheumatoid arthritis and psoriatic arthritis).”

Dr Chow further explains that what makes these drugs so different from other drugs used to treat RA that modify the immune system is that biologics affect a specific component of the immune system, not the entire immune system. Thus, these drugs theoretically have fewer side effects. She says that what many people don’t realise is that RA is not a disease of the joints. It is actually as disease of the immune system.

“It is an autoimmune disease in which, for unknown reasons, a person’s immune system attacks his or her own body tissues, causing chronic pain and irreversible deterioration of the joints,” she explains. “It is disabling and can lead to substantial loss of mobility due to pain and joint destruction.”

The symptoms that distinguish RA from other forms of arthritis are inflammation and softtissue swelling of many joints at the same time (polyarthritis). It may start gradually or with a sudden, severe attack with flu-like symptoms. In some people the disease will be mild with periods of activity or joint inflammation (flare-ups) and inactivity (remissions).

In other cases the disease will be continuously active and appear to get worse, or progress, over time. You may feel weak and tired, you may have a fever or lose weight, but joint pain will be the main problem.

RA affects approximately 0.5 to one per cent of the adult population worldwide. Statistics from the AFM reveal that about five in a 1,000 people are affected in Malaysia.

It has consequences not only for people with the condition but also for their families, friends and employers. According to the World Health Organisation, more than 50 per cent of patients with RA completely stop working within 10 years of the disease onset.

Dr Chow says that early intervention is essential. “Since there is no cure for RA, the goal of treatment is to minimise patients’ symptoms and disability by introducing appropriate medical therapy early on, before the joints are permanently damaged.”

Current treatments, which include NSAIDS, COX-2 inhibitors, corticosteroids, disease-modifying anti-rheumatic drugs (DMARDS), immunosuppressants and biologics, offer most patients good to excellent relief of symptoms and the ability to continue to function at or near normal levels. However, biologics is not used a first-line treatment for RA because of the cost factor. In fact, fewer than 100 people are on biologics for treatment of their RA in Malaysia.

“The average price of the biologics treatment costs about RM4,000 to RM5,000 a month,” says Dr Chow. “And as this is not funded by the Government and is a lifelong treatment, not many people can afford it.”

“Biologics is only offered as an option if the other treatments fail,” she adds.

In Narehan’s case, she says that these days she has almost forgotten that she is an RA patient. “The treatment allows me to do anything like a ‘normal’ person would. I enjoy my work, I travel, I scuba-dive, I give lectures everywhere, I watch soccer games and take night drives,” she smiles. “I think doing the things you enjoy keeps you younger and healthier.”

Do you have these symptoms?

- Joint pain with warmth and swelling, especially in the small joints of the hands, wrists and feet
- Pain in more than one joint at the same time
- Fatigue
- Morning stiffness that lasts an hour or more
- Limited movement or function of joints
- Painless lumps under the skin around your elbows and hands
- Low-grade fever
- Weakness

Note: This checklist is not a formal diagnostic tool. It is meant to help you identify symptoms that can be caused by rheumatoid arthritis. Please talk to your doctor.

Source: Touchpoints in Rheumatoid Arthritis booklet by Wyeth Pharmaceuticals

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