Rheumatoid arthritis affects more than joints

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DEAR DR. DONOHUE: I was diagnosed with rheumatoid arthritis in 2005. My rheumatologist put me on methotrexate. I had many side effects from methotrexate, and it was not working as well as it had been, so my doctor put me on hydroxychloroquine (Plaquenil). The thought of going on needles scares me. I hate them.

My fingers are not disfigured, like some of those with rheumatoid arthritis are. What makes fingers crooked? I worry about what these toxic medications have done and will do. Now I need my vision checked every four months because of Plaquenil. — A.F.

ANSWER: Those medicines have saved you from the toxic disease rheumatoid arthritis. Unlike the more common variety of arthritis, osteoarthritis, which is limited to joints only, rheumatoid arthritis not only can destroy joints, but it can cause damage to many organs throughout the body. It leaves patients feeling wiped out. It can attack the lungs and the lung covering. It might inflame the heart covering. The principle for treating rheumatoid arthritis is to treat it early with medicines that can stop the progression of the disease. Truly, the illness is far more destructive than any of the remedies used for it. Take Plaquenil. It is true that it can damage the retina. But your regular eye checkups will show if retinal problems are arising, and, if they are, the drug is stopped.

The disfigurement of fingers that is sometimes seen with rheumatoid arthritis comes about because finger joints become partially or wholly dislocated. The fingers drift to the side and downward. That it hasn’t happened to you could be the result of taking disease-modifying drugs like methotrexate and Plaquenil early on. It may never happen to you. The treatment of rheumatoid arthritis has been revolutionized in the past two decades with the drugs you have taken and with drugs called biologicals, which also slow the progression of this illness. They are given by injection. If you ever come to need them, you have to get over your needle aversion. They work wonders.

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The booklet on arthritis explains the more common kinds of it and their treatments. Readers can order a copy by writing: Dr. Donohue — No. 301, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I’m the victim of Guillain-Barre syndrome. Please explain it in lay person’s terms, as I have difficulty explaining it to family and friends. — V.A.

ANSWER: Guillain (gee-YAWN) Barre (buh-RAY) syndrome is the sudden onset of paralysis that often starts with tingling or peculiar sensations in the feet. In fairly rapid sequence, the feet and legs become weak and then paralyzed. The paralysis ascends in the body and can affect breathing muscles. When it does, doctors have to put patients on ventilators. The illness usually is preceded by three weeks or so by a respiratory or digestive tract infection. Those illnesses stimulate the immune system to make antibodies that attack nerve insulation. Nerves are short-circuited, and that’s the cause of the paralysis. Pain in the back or extremities can be a presenting feature.

The paralysis reaches its maximum in three or four weeks. Two weeks later, recovery begins. About 85 percent of patients recover within a year. Five percent to 10 percent suffer a relapse. A small number succumb to this illness.

DEAR DR. DONOHUE: They think my daughter has cystitis of the bladder. She has terrible pain. She has seen doctor after doctor. What can be done? — F.C.

ANSWER: When people hear the word “cystitis,” they think of bladder infection. Your daughter, I believe, has interstitial (IN-tur-STISH-ul) cystitis, an inflammation of the bladder not due to infection. It does have treatment. The oral drug Elmiron is one. Bathing the bladder with lidocaine (a drug that dampens pain) or DMSO, a drug that calms inflammation, often works. If your daughter hasn’t seen a urologist, she should, or a gynecological urologist — a urologist trained in both gynecology and urology.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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