Joint Pain Forum – News you can use!
the rescue for Arthritis sufferers?
is a breakthrough treatment for rheumatoid arthritis but it is costly,
writes M. Kaur
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
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
“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).
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
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.
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
- 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
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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