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ASSAULT
ON ARTHRITIS
New meds and method stop the pain
BY
LES GAPAY
DOTTIE WEYANT, 57, AN
OFFICE MANAGER AND PART-TIME WAITRESS IN PAPILLION, NEBRASKA, RECALLS
THAT her arthritis used to be so painful that she could hardly walk.
"It hurt so bad that I cried'' she says. Carrying trays of food
made her right shoulder ache. She also developed swelling and pain
in her knuckles, wrists, and one knee.
Then Weyant went to the
University of Nebraska Medical Center, in Omaha, to be tested for
rheumatoid arthritis and was asked if she would take part in a study
that was just beginning. It involved a new experimental therapy
to treat rheumatoid arthritis which affects 2.1 million Americans
Researchers at the university
were administering the drug minocycline, an antibiotic commonly
used to treat acne, to allay the symptoms of arthritis. After six
weeks on the drug, Weyant found herself free of pain. "What a miracle,''
she says. However, when Weyant stopped the treatment, the disease
flared up again. So she resumed the medication and since then has
been able to keep her arthritis in remission. "Now l can keep up
with all the young chicks at the restaurant," she says.
Ben Miller, of Cascade,
Montana, swears by another new treatment method he's been using
for his osteoarthritis, a condition that is very different from
rheumatoid arthritis. Osteoarthritis is caused by the breakdown
of cartilage in the joints, and affects 15.8 million people in the
United States. Miller, 66, says he wore out both knees after a lifetime
of mountain climbing and outdoor work. It was bone rubbing against
bone, he explains. You could actually hear it when I moved. It hurt
me so much that I couldn't sleep. Orthopedic surgeons said I was
the perfect candidate for knee replacements.'' Just about the time
Miller was considering having the surgery, he heard about a new
treatment involving the injection of a substance called hyaluronic
acid, which lubricates and may protect the affected joint. Four
days after Miller got the first injection in his knees, he felt
relief. So much relief, in fact, that he was later able to take
part in an eight-day hike in Wyoming during which he walked 31 miles
to an elevation of 11000 feet with a 4O-pound pack on his back,
"My doctor was amazed '' says Miller. I'm planning another big hike
next summer.''
These two new treatment
methods for the most common types of arthritis aren't some far-out
fringe therapies, but part of a series of recent and upcoming treatments
being evaluated to treat these diseases. This progress comes at
an especially crucial time, as the population is aging and becoming
more and more prone to some types of arthritis, especially osteoarthritis.
"A lot of exciting new treatments are being explored,'' says Doyt
Conn, M.D., senior vice president for medical affairs of the nonprofit
Arthritis Foundtion, a 50-year-old research and educational group
in Atlanta, Georgia. "We are now managing and controlling many diseases
better. Even though we haven't found a cure, we're improving the
quality of life for people with arthritis.''
Recent studies show that
minocycline, the antibiotic that is helping Weyant may provide some
patients with ''dramatic responses'' in early rheumatoid arthritis,
an immune-system disease, says James O'Dell, M.D., chief of rheumatology
at the University of Nebraska, who led the Nebraska study. Earlier
studies showed modest improvement in patients who were in the later
stages of the illness. Exactly how the drug works is still unknown.
"However, minocycline does appear to block enzymes that break down
cartilage,' O'De1l explains.
Miller's rheumatologist,
Elton J. Adams, M.D., of Great Falls, Montana, says he's injected
the joints of about 80 patients with hyaluronic acid, and about
75 to 80 percent have gotten pain relief. "It also allows some people
to get off anti-inflammatory drugs that can have dangerous side
effects when taken on a long-term basis'' he says. Adams also says
that the substance can help patients who are not good candidates
for joint replacements. Mark E. Adams, M.D. (no relation), the Arthritis
Society Chair in Rheumatic Diseases at the University of Calgary,
says studies show that a series of three hyaluronic acid injections
provides relief for up to eight months and can be repeated. Other
studies indicate that tobacco smoking causes a greater number of
more severe complications in people who have rheumatoid arthritis.
And, of course, being overweight puts extra stress on joints and
can put people at risk for or exacerbate already existing osteoarthritis.
Experts say arthritis research and treatment is at its most hopeful
juncture in history. "We can do a lot to control the disease and
blunt its impact," says Conn of the Arthritis Foundation.
"For osteoarthritis,
various agents eventually will be able to slow down the disease,
to retard it'' predicts Roland W. Moskowitz, M.D., an internationally
known arthritis expert at Case Westem Reserve University in Cleveland.
"Advances in our understanding and treatment of rheumatoid arthritis
allow hope that, like polio, this disease may one day disappear.''
The Arthritis Foundation has 150 local offices, which offer information
on arthritis, educational courses, and tailored exercise programs.
You can receive more information by calling 8-283-7800, visiting
the Web site at http:/www.arthritis.org, or by writing to the Foundation
at PO Box 7669, Atlanta, GA 30357-0669.
COMING
TO A PHARMACY NEAR YOU
Permanent cures for the
various forms of arthritis are probably a long way off, but a number
of newly developed treatments may spell relief for some of the nearly
40 million Americans who suffer from these debilitating diseases.
Watch for the availability of the following products.
* Enbrel is a biological
drug that inhibits a specific protein called tumor necrosis factor
(TNF). Scientists have discovered that an excess of TNF in the body
plays a role in causing rheumatoid arthritis and other inflammatory
diseases. Enbrel, developed by Immunex Corporation, acts as a mop,
soaking up excess TNF. Pending FDA approval, Enbrel could be available
by the end of this year or early in 1999. A new class of anti-inflammatory
drug called Cox-2 inhibitors works to isolate and attack the Cox-2
enzyme, which is believed to contribute heavily to arthritic inflammation
and pain. The old class of anti-inflammatory attacked just one enzyme,
Cox, which causes painful inflamma- tion. But Cox also protects
the stomach and kidneys, which is why efforts to block this enzyme
also resulted in negative and sometimes dangerous side effects,
such as ulcers and gastric upset. However, subsequent research has
identified two forms of the Cox enzyme: Cox-l, which protects the
stomach, and Cox-2, which causes the inflammation and pain. With
these new Cox-2 selectives, you'll get the good effects of the old
anti- inflammatory drugs.'' says the University of Nebraska's James
O'Dell, without the bad., Two companies, Searle and Merck, both
hope to intro- duce their versions of this new type of drug, Celecoxib
and Viox, in early 1999, pending FDA approval.
They are likely to help
those with both osteoarthritis and rheumatoid arthritis. . Nutritional
supplements glucosamine and chondroitin sulfate have taken center
stage on the alternative-medicine front in the war against os- teoarthritis.
Both compounds are the subject of a recent bestseller, The Arthritis
Cure (St. Martin's Press, 1997), by Jason Theodosakis, M.D. Theodosakis
says that these nutrients bolster cartilage by stimulating new cart
lage growth and inhibiting naturally occurring enzymes that destroy
cartilage.
Jane Brody, health columnist
for The New Fork Times, reported that after she spent eight weeks
on this program the osteoarthritis in her knees improved dramatically.
*1 do not have pain-free knees, but I no longer have disabling discomfort
Brody said after more than a year on the teatment. David Pisetsky,
M.D., Ph.D., co-director of Duke University's Duke Arthritis Center
in Durham, North Carolina, cautions that 'the trials on these supplements
have been limited and report only short-term results.'' He also
reminds would-be users that the supplements, which are sold at health
stores, are neither FDA-approved nor regulated. Laila Hirschfeld
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