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Progress made in treatment of debilitating joint condition / Smoking, gum disease linked to raised risk

The Yomiuri Shimbun

The Yomiuri ShimbunRheumatoid arthritis is an illness that stiffens joints and causes symptoms such as swelling and other kinds of inflammation.

If the symptoms worsen, joints can become deformed and immobile. Patients can have difficulty walking and face serious deterioration of their quality of life.

In recent years, however, there has been remarkable progress in treatment, partly thanks to the development of new medicines.

What is the cause?

Bones are covered with cartilage where they meet in a joint, which works like a cushion. The joint as a whole is covered with membranes called synovium.

Immune cells in synovial membranes discharge substances that can cause inflammation, which makes the membranes thicker, and can cause the cartilage or bones to be damaged. This condition is rheumatoid arthritis.

Viral infections are suspected of triggering this illness, but why it produces such symptoms is still unknown.

Research on patients indicates that people with specific types of proteins due to genetically inherited factors tend to develop the illness. Other risk factors are smoking and carrying germs that cause gum disease.

Medical experts believe that if two or more of these factors combine, the illness may follow.

What are the symptoms?

Patients initially feel stiffness in their joints in the early morning. If the condition worsens, they begin to feel swelling or pain.

Joints eventually harden and become deformed, and it becomes difficult to bend and stretch parts of the body.

Medical treatment can prevent deformity, but if the condition is left untreated, within four years about half of patients develop the serious condition of deformed joints.

In many cases, the illness develops in the fingers, toes and knees. In fingers, it often appears in the second or third joints.

Another characteristic of the illness is that it spreads symmetrically in affected body parts.

In some cases, systemic symptoms such as a mild fever and a sense of fatigue appear.

There is estimated to be between 700,000 and 1 million rheumatoid arthritis patients in Japan. There are about three times as many female patients as male, and in a remarkable number of cases, they develop the illness between their 30s and 50s.

How to treat it

The illness is first treated with medication, primarily anti-rheumatic drugs such as Methotrexate that suppress immune function. Depending on the symptoms, steroids to ease inflammation and painkillers are also used, all applied orally.

If taking such drugs for two to three months is not effective, biological drugs, which appeared in the 2000s, are used. These medications obstruct the functions of the substance that causes inflammation and have a high probability of slowing down the illness’ development.

The monthly cost of Methotrexate is several thousand yen, but biological drugs can exceed ¥50,000 in some cases.

Even if the drugs stop the illness developing, it recurs for 50 percent to 70 percent of patients who stop taking the medication. If they resume using the drugs, the illness’ development can be stopped again.

If the joints are damaged, surgery is performed because the drugs are not longer expected to improve the patient’s condition.

Broken cartilage or bone is chipped off and replaced with artificial joints made of metal or polyethylene. This method is used on larger joints such as shoulders, elbows and knees.

How to prevent it

One preventive measure is to stop smoking, as smoking increases the presence of germs that cause gum disease.

One report said smoking while taking medication for rheumatoid arthritis lowers the effectiveness of the treatment. Giving up smoking is therefore important not only for prevention but also for treatment.

Another effective measure is to keep the inside of the mouth clean and improve the intestinal environment.

To prevent viral infections, it is also important to get enough sleep and relaxation, and eat well-balanced, nutritious meals.

People who develop rheumatoid arthritis should not put excessive stress on their joints.Speech

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