Re: What our long term prognosis? Re: I have to disagree

[Guest guest]

,

I am so sorry about your mother. Today, the prognosis of the average RA

patient is much improved. Those recently diagnosed and appropriately treated

will likely have a longer and much better quality life than your mother did.

Research has shown that even treatment of RA with MTX alone, for those who

can tolerate it and for whom it is effective, is associated with reduced

mortality rates. Quality of life is also improved. Study of the use of

biologics to treat RA has demonstrated, to date, similar results.

Because the biologics for RA have only been FDA-approved since late 1998

(Enbrel was the first, followed by Remicade a year later), " long-term "

post-marketing outcomes with biologics are only approaching the ten-year

mark (and this is true for the anti-TNF biologics only). But, so far, the

results are very encouraging.

Currently, rheumatologists and institutions are aiming for remission or " no

evidence of disease (NED) " (or should be!) in the treatment of RA. This is a

big change from the philosophy that prevailed in your mother's time. And

this revolutionary approach results in better quality of life and longer

lives for RA patients.

As you noted, in your mother's era, they didn't have the treatments we do

today. Also, the risks of long-term prednisone weren't fully appreciated. In

addition, it was not widely understood that inflammation left unchecked

would affect much more than the joints. We may learn that hitting the

disease early and hard and achieving tight control of inflammation is more

important than the specific DMARD or combination of DMARDs used to do so.

Unfortunately, though there are some fairly reliable markers, right now,

there is no precise way to predict which patients will have more severe

disease and which patients will respond to which, if any, of the available

treatments. Thus, a rheumatologist may be hesitant to speculate on a

prognosis for a given patient. But the prognosis for RA patients as a whole

has improved markedly since the time of your mother's diagnosis.

In my view, the most exciting news is that RA, if treated early and

aggressively enough, may possibly be halted and remission achieved both with

and WITHOUT continued drug therapy.

" Long-term impact of early treatment on radiographic progression in

rheumatoid arthritis: A meta-analysis " (Dec 2006):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=17139662

" Treatment with TNF-blockers and mortality risk in patients with rheumatoid

arthritis " (Dec 2006):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=17158824

" Can remission be maintained with or without further drug therapy in

rheumatoid arthritis? " (Nov-Dec 2006):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=17083760

" Strategies to control disease in rheumatoid arthritis with tumor necrosis

factor agonists - an opportunity to improve outcomes " (Nov 2006):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=17075598

" Progression of radiographic joint damage in different eras: trends toward

milder disease in rheumatoid arthritis are attributable to improved

treatment " (Sep 2006):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16540549

" Improving Outcomes in Rheumatoid Arthritis: What Determines Decisions to

Change Ineffective Therapy? " (Jul 2006):

http://www.jrheum.com/subscribers/06/07/1213.html

" Probable rheumatoid arthritis methotrexate versus placebo therapy (PROMPT)

study: indications for a window of opportunity in the treatment of patients

with undifferentiated arthritis " (Jun 2006):

http://eular.bmj.com/cgi/content/abstract/ardmtg;65/Suppl_2/54

" Treatment of rheumatoid arthritis in 2005: prompt, aggressive and

customized " (Mar 2005):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=15828371

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" No increased mortality in patients with rheumatoid arthritis: up to 10

years of follow up from disease onset " (Dec 2000)

Excerpt:

It has long been suggested that patients with RA, especially the more severe

cases, have a shortened life expectancy compared with the general

population.11 In this study of an inception cohort of patients with recent

onset RA we conclude that the death rate up to 10 years of follow up of

patients with RA was not significantly different from the expected mortality

of the general population. Therefore we suggest that the aggressive

therapeutic strategies introduced since the 1980s have not only resulted in

an improved disease course but also in a better long term outcome. But we

are aware that other possibilities cannot be excluded for example, some

evidence suggesting that RA is getting milder and less common and the fact

that patients attending hospitals are more likely to receive preventive

treatment for comorbidities. However, as some studies have suggested that

the mortality of patients with RA compared with the general population

increases with the duration of the disease, further research (longer follow

up) may be necessary.9 In this study only age at the start and male sex were

statistically significant prognostic factors for mortality. "

http://ard.bmj.com/cgi/content/full/59/12/954

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Not an MD

[ ] What our long term prognosis? Re: I have to disagree

> My pain level never really goes down, I just get better pain meds once

> in a while to better deal with the pain.

>

> I do have a question and this is probably better for to answer.

> What is the 'new' prognosis for us long term RA folks. I know it isn't

> the same as my mother when she was in the end stage of the disease;

> gnarled joints, surgery, fibrosis of her lungs, cushing's from too much

> prednisone and a death I do not want to have one like. But that was

> over twenty years ago, before even methrotrexate. MTX was approved the

> year she died. So has there been any research in what long term RA

> looks like with people who have had MTX and or MTX/biologic combo?

>

> I do not have a lot of bone destruction, but major amount of tenonitis,

> synovitis, and just in the past few months started getting rheumatoid

> nodules on my hands, feet, arms and the back of my neck. That and my

> pain level is increasing.

>

> Dennis this was a good thing to bring up. And I don't think you were

> rude at all. How's saying one medical profession can be caring and

> another not be, be rude?

>

>