For the last few blog updates I have blogged about upcoming events that will help raise awareness of rheumatoid arthritis. For this blog post I believe it is imperative that my voice be heard. I want my followers to know that arthritis is not just a topic I am interested in, but that I suffer from it as well. Because of this, I know that arthritis is a tricky disease.
When people think of arthritis, they think of stiffness of joints, pain and inflammation, which is true. However, what most people don’t realize is that arthritis is just a generic term. According to the Arthritis Foundation, arthritis is a broad term for more than 100 different types of arthritis. Another thing tricky about arthritis is that a patient can be diagnosed with a certain type of arthritis, and be treated for it and then later down the road be told by a doctor that it was incorrectly diagnosed and the patient has a different form of arthritis.
This is exactly what happened to me. Several years ago when I was diagnosed with arthritis, my rheumatologist told me I had rheumatoid arthritis. But aspects of my disease didn’t follow the normal pattern of rheumatoid arthritis. However, since no other symptoms pronounced themselves, my doctor had to assume that it was rheumatoid arthritis. Therefore, she had to treat me for that type of illness. A year in a half ago I developed a rash on my arm and leg. No doctor knew what it was, and no treatment seemed to work. I finally showed these rashes to my rheumatologist. She believed these rashes to be psoriasis. With testing, her diagnosis was confirmed, and it was determined, that I never had rheumatoid arthritis, I in fact had psoriatic arthritis instead. Also the medication that I was on to treat the rheumatoid arthritis, made the psoriasis worse. Registered Nurse, Pamela Fields explains that arthritis is an autoimmune disease and these diseases are extremely difficult to diagnose. “Doctors choose their treatments based on the information available. If one treatment doesn’t work, they try another. Prescribing medications is not an exact science. Often autoimmune diseases cannot yet be treated directly, but are treated according to symptoms associated with the condition,” Fields said.
Why the psoriasis patches didn’t pronounce itself until a year ago is a medical mystery to my rheumatologist. However, now that we look back all the signs line up. According to the national institute of health, psoriatic arthritis affects the skin with rashes, and inflames the ends of fingers, the ends of toes, and the back, which was exactly where my arthritis was. For some reason the psoriasis didn’t appear until sometime later. Dr. Tim Mynes, an urgent care doctor, explains that psoriatic arthritis is not common. “Psoriatic arthritis has symptoms much like rheumatoid arthritis. 1% of people in the US have psoriatic arthritis, and 5-7% of people who have psoriasis have arthritis with it,” Mynes said. Mynes went on to explain that psoriatic arthritis can sometimes be hereditary, and is usually noticeable in a person by their 20s. Both Mynes and Fields stressed that it was important that a person get treated immediately when symptoms pronounce themselves, or a person might suffer from bone destruction.
As I said above, the medication I was on when it was thought that I had rheumatoid arthritis actually made the psoriatic arthritis worse. Which raised the question, what treatment would work the best? And what made my situation worse, was I already had a suppressed immune system, and some of the most effective treatment options would put me at risk of weakening my immune system even more. My rheumatologist decided that the best option was to put me on a medication called sulfasalazine. It had no side effects, would help control the disease, and as my rheumatologist said, “It’s an old but goody drug.” Pharmacist, Amy Decamp is able to give some insight on what drugs are good and most commonly used for arthritis. “The most common meds used are of course NSAIDs, MTX, and TFN-AI, and the immunosuppressants. All have benefits and downfalls. NSAIDs are good for inflammation, but may cause stomach issues and skin flare-ups. MXT can decrease joint damage but can also be pretty toxic causing lung/kidney/lung issues. TFN-AIs are expensive, but are quite good at keeping the disease under control as long as you are not prone to infection. I also read that teenagers who use these drugs may have an increased change of developing cancer. The immunosuppressants are great for controlling disease, but again greatly increase the risk of infection and kidney/liver problems,” Decamp said.
In the case of professional golfer, Phil Mickleson, Enbrel is the drug for him. Mickleson surprised the sports world when he announced in 2010 that he suffered from psoriatic arthritis. According to golf digest, Mickleson doctor prescribed a drug called Embrel. The golfer injects himself weekly with this medicine. As many other’s with psoriatic arthritis, Mickleson has had great results with Embrel. Luckily, this drug has given Mickleson his quality of life back on and off the golf course.
So yes, arthritis can be tricky, take a long time to get under control, and be painful at times, but people still can have a full rich life. I can say this because I have personally experienced this tricky thing. With the right diagnosis, medication, and outlook on life, we can trick arthritis. For more information on rheumatoid arthritis and psoriatic arthritis, or Phil Mickleson, go to http://www.niams.nih.gov/Health_Info/Arthritis/arthritis_rheumatic_qa.asp, http://www.arthritis.org/, and http://www.golfdigest.com/magazine/2010-12/dave-kindred-arthritis