DEAR DR. DONOHUE: I am 73 and was diagnosed with rheumatoid arthritis six months ago. Isn’t this old for developing it? My mother had it and died from cancer. Is rheumatoid arthritis connected to cancer in any way? My son also has it. Can it be inherited? What is the life expectancy of someone with it? Can it be controlled? – R.B.

ANSWER:
Rheumatoid arthritis can appear at any age, but 80 percent of patients develop it between the ages of 35 and 50. Men – a minority of rheumatoid arthritis patients – usually come down with it after age 45; women, at younger ages.

A few somewhat unusual cancers are associated with rheumatoid arthritis. Don’t take that to mean that all RA patients get cancer. That is not the case. But arthritis patients have a greater-than-average incidence of coming down with lymphomas (lymph node cancers), leukemias (white blood cell cancers) and multiple myeloma (bone marrow cancer).

The inheritance question is a good one. The best way to study inherited illnesses is to study identical twins, who have identical genes. If one identical twin has rheumatoid arthritis, the other twin has a 30 percent to 50 percent chance of also coming down with it. Inheritance, therefore, has a hand in it, but genes are not the sole factor causing it.

The life expectancy of people with rheumatoid arthritis is slightly less than that of the general public. RA patients die from the same things that the general population dies of – heart disease, stroke, cancer and infections – but they succumb around three to seven years earlier than the rest of the population.

Control of rheumatoid arthritis is possible for most patients. Older medicines, such as anti-inflammatory drugs – like ibuprofen, aspirin and indomethacin – still have a valued place in treatment and still make a great contribution to control. In addition, new medicines such as Arava, Enbrel, Remicade, Humira and Kineret open new doors for treatment and provide novel ways of attacking this disease.

DEAR DR. DONOHUE: My mother has a blockage in her heart arteries. They tell me there is nothing to do for her because she is too old and would die on the operating room table. I asked about balloon treatment, and they said no. She has not been given any new medicines, and we wonder if all we can do is wait until death arrives. Can’t something be done? – C.D.

ANSWER:
Age is no barrier to any treatment for blocked heart arteries – surgical, medicinal or mechanical (the opening up of clogged arteries with a balloon). Health is a barrier. It would not make sense to subject a frail person in fragile health to the trauma of invasive procedures.

If an elderly person is not on death’s door, then surgery or balloon dilation of obstructed heart arteries can be undertaken. Older people, naturally, have a greater risk of surgical complications, but weighing risks with benefits allows surgery for many elderly people.

There are tons of medicines for heart disease, and your mother might benefit from any number of them. Why not ask another doctor to take a look at her?

DEAR DR. DONOHUE: I have a pile of your columns, but I can’t find one that I need. It is about the difference between the systolic and diastolic blood pressure readings. Could you repeat the information? – J.C.

ANSWER:
The difference between the systolic pressure – the first number – and the diastolic pressure – the second number – is called the pulse pressure. A high pulse pressure indicates hardened arteries, and it is a better predictor of the risk for a heart attack than is the systolic or diastolic pressure alone.

A pulse pressure greater than 60 can be a cause for concern.

Medicine is in a state of constant flux. What was true yesterday is not true today. Pulse pressure is a case in point. It is still considered a valuable gauge of heart and blood vessel health, but it should not be the sole determinant in judging a person’s risk.

DEAR DR. DONOHUE: In 1990 I quit smoking and had a flare-up of ulcerative colitis. In about a week I ended up in the hospital. This was the worst attack I had ever had. In the past 10 years I have tried to quit smoking several times and experienced flare-ups each time. My doctor has no solution to my problem. Do you have any insight into this matter? – T.D.

ANSWER:
It’s a strange but true fact: Cigarette smokers have a lower risk of having ulcerative colitis, and, if they do have it, cigarette smoking mitigates attacks. Doctors are left scratching their heads over why this is so.

An ulcerative colitis patient who happens to be a smoker almost always has an attack when smoking is stopped.

Smoking is not a good way to keep ulcerative colitis under control. The cure is worse than the disease.

Have you tried using a nicotine patch when you stop? A patch with the highest nicotine dose might prevent a relapse of ulcerative colitis. Nicotine gum is another possible solution. Chew just enough gum to keep the disease dormant.

Or have you tried a relatively new therapy – Remicade? Treatment with it might permit you to stop smoking without suffering a relapse.

Another odd fact is that smoking makes Crohn’s disease worse. Crohn’s disease is ulcerative colitis’s twin. They are the two inflammatory bowel diseases.

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.


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