Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei
Hayeshua Hospital
As you picked up your copy of Yated today, you
probably did not realize that for people with rheumatoid
arthritis, picking up anything can be a painful experience.
These people suffer with joint pain especially in the
morning, and this is a disease seen much more frequently in
females than males. Commonly it begins in the 40-60 age
range, which is also the time that osteo-arthritis,
discussed last week, can start to occur. The presentation,
however, is different. Rheumatoid spares the last joint on
the fingers, and is usually accompanied by other symptoms
such as fatigue, weakness and multiple joint pain. It
commonly also affects the foot and wrist as well. It can
have times of worse pains and times when it feels better.
The diagnosis of rheumatoid is with a simple blood test, but
when there is enough fluid accumulation in the joint,
putting a needle into the joint and draining the fluid is
the best way to make the diagnosis (by sending it to the
lab) and it makes the patient feel better. At the same time,
medications can be put into the joints that will help in
controlling the pain. The chief mistake that can be made in
diagnosis is missing a septic joint, or a joint in which
bacteria have invaded. This is a true emergency that
requires quick drainage and antibiotics with
hospitalization.
Rheumatoid can have other effects on the body including
involvement of the lung and nerves.
Treatment includes rest to calm down the inflammation, and
medications. Medications include aspirin or ibuprofen-like
drugs, with the addition early of steroids such as
prednisone. Other drugs often used are such odd drugs as
gold, penicillamine, a drug often used for malaria,
azathioprine and cyclosporine, drugs used to aid in
transplant acceptance, methotrexate, a drug used in fighting
cancer, and sulfasalazine, a drug used in Crohn's
disease.
All have their own side effects and this may not be an easy
disease to treat. A new more effective drug has been
approved for use in the USA but the cost is almost $15,000 a
year. While these therapies can help immensely, the disease
remains incurable.
JRA, a pediatric form of this disease exists that looks
similar, but we must go. If you'd like to hear about it,
please write me in care of the Yated.
A message from Glaxo, sponsor of this column. Asthma
can be worse with the chill of winter or the early allergies
and exercising that one does with the coming of spring.
Serevent beforehand may prevent trouble. Remember Serevent
is not for acute asthma attacks but for mild predictable
asthma, it is a wonderful drug.
