Health Matters: A look at Rheumatoid Arthritis treatmentsDr. Joshua Wynne answers the question: I have had rheumatoid arthritis for a while, and wonder if there are any new treatments available.
By: Dr. Joshua Wynne, Grand Forks Herald
Q. I have had rheumatoid arthritis for a while, and wonder if there are any new treatments available.
A. There are many different types of arthritis. Many of us— especially as we age — develop joint aches and pains that are related to degenerative changes. Hence, this very common type of arthritis is called degenerative arthritis. Less common but even more destructive is rheumatoid arthritis (RA), which is associated with inflammatory joint changes (often manifested by warmth and swelling of the involved joint).
Many years ago when I was a physician-in-training, patients with RA were routinely hospitalized to treat flare-ups of the disease. In fact, the health care system in Boston in which I worked had an entire hospital dedicated to the treatment of patients with RA and related joint diseases! Fortunately, options for treating rheumatoid arthritis have improved substantially over the past two decades.
Treatment with the drug methotrexate is now routine, whereas we were just trying it out when I first started practice. And we use it earlier in the course of the disease, with about a third of RA patients responding quite favorably. A variety of other drugs are now available in addition to methotrexate, and they work well to control the inflammation and improve the functional well-being of the patient. So the good news is that using a variety of medicines for RA results in substantial clinical improvement in many patients.
Please visit your doctor again and see what else can be done to help quiet down your arthritis. I think that you will be feeling better soon!
Q. I am on dialysis and am scheduled for a kidney transplant. So I was unnerved to read about a kidney transplant recipient who died from rabies that he got from the transplanted kidney! How concerned should I be?
A. I can understand your concern! However, your risk of a similar problem is extremely low. It turns out that this is only the third documented case of transmission of rabies in a solid organ like the kidney, with the first case having been reported in 2004. So in the subsequent nine years, there have been “only” two cases reported.
And three other patients who received rabies-tainted transplants survived after treatment with rabies vaccine. What was particularly unusual in the recent case that you mention was the long incubation period of 18 months from transplantation until death. It turns out that the donor, a previously healthy man who died from presumed food poisoning attributed to eating tainted fish, actually had contracted rabies from at least two untreated raccoon bites several months before he became sick.
Unfortunately, rabies was not suspected at the time of the donor’s death, and only became apparent when the recipient showed signs of rabies. Although donor tissue is screened for a variety of diseases like HIV and hepatitis viruses, screening for rabies is not practical because of the time required. Nevertheless, this case has stimulated discussion in medical transplant circles as to what further steps we need to take. Fortunately, the likelihood is that you will do just fine after your transplant. Good luck!
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences. Submit a question to Health Matters at firstname.lastname@example.org or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please. The content of this column is for informational purposes only and does not substitute for professional medical advice or care.