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Live Chat to Prof David Isenberg of the Arthritis Research Campaign |
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The Check Up live web chat about Arthritis has now finished but you can read the full transcript below.
Barbara:
We will have to stop there because we're out of time. Our thanks to Professor Isenberg of University College London and Jane Tadman of the Arthritis Research Campaign. We have been made aware from all your questions and comments of just how widespread arthritis is. And how difficult to find your way among the many treatments - conventional and otherwise - that are out there. Fortunately some of the newest, more sophisticated drugs for rheumatoid arthritis do sound very promising. Always remember it's worth going back to your doctor to see what else may be available for you to try. Good luck.
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From Lynn Smyth:
I'm a 24 year old nurse who has been experiencing joint pains from I was 18. I was diagnosed just over 1 year ago with palindromic rheumatoid arthritis! At present I am awaiting a bone scan.
This past month I have been experiencing terrible pain and I have tried mobic, vioxx and just recently voltarol to no effect! Is there any other medication I can take? I admit I'm about 1.5 stones overweight but am so sore I cannot face exercise other than to swim once a week!
Your help is much appreciated
Jane Tadman (Arthritis Research campaign):
Palindromic arthritis is a type of arthritis that comes and goes and is treated in the same way as other types of arthritis. Therefore, you should be on a disease modifying drug, such as methatrexate as well as the others you mention which are effectively only painkillers. I would seek the advice of a rheumatologist. Excess weight puts undue strain on the joints, so you would be well advised to lose it by preferable non-weight bearing exercise such as your swimming, or try cycling. A phsyiotherapist may be able to suggest a suitable exercise regime.
From Dave Jones:
I have had gout for some years, particularly in the left knee. I would like to ask:
1. Are there any links between gout and arthritis?
2. What foods should be avoided if you suffer from gout?
Jane Tadman (Arthritis Research campaign):
1. Gout is an inflammatory form of arthritis.
2. Basic rule of thumb is red meat, alcohol, yeast products and oily fish. Drink plenty of water and lose any excess weight.
From Joyce Stretton:
Can anti-malarial tablets be taken in conjunction with other drugs for rhuematiod arthritis?
Jane Tadman (Arthritis Research campaign):
They are usually taken with NSAID drugs.
From Helen Hall:
Hi - can you tell me which anti-malarials can cause relief of symptoms and does this apply to osteoarthritis as well as rheumatoid?
Jane Tadman (Arthritis Research campaign):
Anti-malarials are only effective in the treatment of rheumatoid arthritis, not in osteoarthritis. It is also effective in the treatment of lupus. The main type of anti malarial prescribed is Hydroxychloroquine.
From Johanne Doherty:
My 14-year old daughter was finally diagnosed in July last year after 2 years of pain and swelling. She now takes methatrexate and voltarol which seems to be helping. We are told she may grow out of it what is the likelihood of this as it now seems to be in all of her joints?
Jane Tadman (Arthritis Research campaign):
Less severe cases of juvenile arthritis do sometimes burn out or the child goes into indefinite remission but this is not always the case. It is very difficult to predict the future outcome of juvenile arthritis. But effective medication usually keeps the condition well under control.
From Anita Hodgeson:
My mother who, although she had painful arthritis in both her shoulder and hip, suddenly deteriorated last summer and is now from being an active 71-year old is a severly disabled 72-year old with both knees her hip base of spine and her shoulder all giving her severe pain is this common or should we look to other causes for this rapid decline?
Jane Tadman (Arthritis Research campaign):
It's unusual for osteoarthritis to deteriorate so quickly as the degeneration of cartilage usually occurs over a long time. I would suggest she gets her GPs advice and considers the possibility that this could be something else. A rheumatologist should be able to make a more satisfactory diagnosis.
From Sylvia Maley:
You mentioned a new type of drug treatment for osteoarthritis - I think it was Cox 2. Could you give some more details please?
Jane Tadman (Arthritis Research campaign):
It's a new type of non-steriodal anti-inflammatory drug used to relieve pain in osteoarthritis and which have fewer side effects, particularly on the stomach. The main types are: Vioxx and Celabrex. Your GP can prescribe these for you.
From Clem Czapp:
Has there been any progression or help, either medically or through surgery, with the problem of nodules I have on my elbows and knuckles? I last saw a consultant on Rheumatoid Arthritis some 20 years ago.
Jane Tadman (Arthritis Research campaign):
Unless the nodules are painful, it's probably best to leave well alone. If they are painful, then your rheumatologist would be the best person to advise on up-to-date ways of treating them. I suggest you ask for a referral from your GP.
From Lesley Davies:
I have lost the feeling in my hands. This has been diagnosed as due to nerve compression in the cervical spine. (I have had osteoarthritis of spine and left hip since my early thirties). The doctor has referred me to a physiotherapy clinic. Will this help restore the feeling in my hands? Also my left hip was declared'severely deteriorated' when I was 36. I am now 62. Sometimes the pain wakes me at night, but when I asked my doctor if I should go on the waiting list for a hip replacement he said I was too young. Is this right?
Jane Tadman (Arthritis Research campaign):
You're not too young for a hip replacement. They're normally carried out on people aged 60 and upwards as the hip replacement should last 15-25 years. Physiotherapy will help the problem in your hand and also taking painkillers or NSAID drugs may also help.
From Linda Wray:
My mother suffers from severe osteoarthritis. She has had it for 40+ YEARS. She is now 77 and has just been prescribed with Warfarin. She has been told that she cannot take any anti-inflamatory drugs with this and is now in continual and severe pain. Are there any drugs that she can take with Warfarin that might help?
Professor David Isenberg:
Ordinary painkilling drugs like paracetamol can be given with warfarin.
From Elva Robinson:
Can RSI lead to arthritis in later life?
Professor David Isenberg:
There is no evidence to support this idea.
From Gary Totten:
Has Infliximab been licenced in the UK for treatment of Psoriatic Arthritis? If so, could there a specific reason why my Rheumatologist has not perscribed it for me along with the 20 mgs of Methatrexate I currently take?
Professor David Isenberg:
It is not yet approved by NICE and therefore strictly speaking cannot "officially" be prescribed for psoriatic arthritis. However, several research studies have reported very encouraging results.
From Louise:
What was the name of the drug that you mentioned that was going to slow the whole process down?
Professor David Isenberg:
The TNF alpha blocking drugs that are currently available are Embril, Infleximab and Humira.
Embril is given by sub-cutaneous injection twice a week and Infliximab is given by intravenous injection every six to eight weeks, Humira is given by sub-cutaneous injection on alternate weeks. These drugs may only be given after patients have been shown to have failed to respond to two conventional drugs (such as methodrexate and sulpur salazine).
From Jo Dalgleish:
The label on Methatrexate says 'Not to be taken with Ibuprofen', but the Doctors say that I can take Ibuprofen? Can I or can't I? Many thanks.
Professor David Isenberg:
Theoretically there are some concerns about taking both simultaneously but in practice many patients do so with no adverse effects at all.
From Hilary Lloyd:
I've had RA for nearly 30 years, same rheumatologist. I'm on 3DMARDS, ESR50up to90, had hip replacement, am awaiting shoulder replacements. Is it too late for Infliximab? My consultant says he's reluctant to prescribe in case I develop Leukaemia.I'm also concerned about mouse cells in Infliximab. Is there also a problem with shingles & Etanercept? Sorry if there are too many questions!
Professor David Isenberg:
Definitely not. If your ESR is still high, the chances are your RA is still active and Infliximab may well help you. The risk of leukaemia is extremely low and the risk of responding to the very small mouse component of Infliximab is equally low. Please note that Infliximab is not a mouse cell!
From Rupert Parson:
I shattered the joint surface at the wrist of my radius last year. The pieces were reassembled via ORIF. I understand that my prognosis is likely Osteoarthritis in this joint within about 10 years.
Is there anything that Professor Isenberg can suggest to delay the onset and/or to mitigate the severity of the Osteoarthritis, through diet, usage, or physiotherapy?
Professor David Isenberg:
Unfortunately, we do not know how to avoid the development of OA in this sort of situation but please note that there is no inevitability of this problem occurring in your case.
From Wilma Van Berkel:
I get intermittent joint pain, particularly in my feet and ankles. At its worst, sudden stabbing pains force me to hop or hobble around. But then 10 minutes later it will be OK. Sometimes it last days, sometimes less than half an hour. I've been checked-out repeatedly with no sign of arthritis or rheumatism. I'm a 46 year old female. Until my 20's, my ankles cracked very loudly.
Professor David Isenberg:
There are forms of "arthritis" which seem short-lived and seem no serious long-term consequences. The cracking of joints does not imply any serious underlying condition. I would doubt from what you've told me that you have any major form of arthritis.
From Alice :
I am 23 and have been on Methotrexate (now 22.5mg weekly) for RA for a year and a half. I find it causes hair loss. Is there anything I can do to counter-act this problem? Also, having graduated from Cambridge this summer, I am finding it hard to find a job (ideally one where I have the flexibility to work from home) that can accommodate my symptoms as well as my graduate status. I find my stamina is affected as well as suffering flare-ups in my joints, such that working a full-time job is out of the question. Would anyone be able to advise on what others in my situation have managed in terms of starting a career taking RA into account?
Professor David Isenberg:
You describe well recognised complications of methotrexate and rheumatoid arthritis. There are several alternatives to Methotrexate, please discuss this with your rheumatologist. The question of obtaining a suitable job is difficult and the key must be to getting optimal control of your RA. This may include the use of the new TNF alpha blocking drugs.
From Samantha Cooper:
I'm 31 years old , just beeen told by the doctors that I possibly have rhuematoid arthritis, am currently taking CELEBREX, can you advise me where I can go for information on the condition, as I know nothing about it. Any advice would be appreciated.
Professor David Isenberg:
Please contact the Arthritis Research Campaign(htp://www.arc.org.uk) who have lots of information sheets about different drugs for arthritis.
From Andrew:
Psoriatic Arthritis - What causes it, what can I do about it? I cannot tolerate NSAIDS because of acid reflux and they dont help much anyway. Is there anything available for sore skin? It feels like sunburn all the time.
I was the organist at our village church until one day two years ago when pain in my fingers made it very difficult to press the keys or span an octave. I have not played since. Now aged 44, what is the prognosis?
Professor David Isenberg:
Five per cent of patients with psoriasis get various types of arthritis. You need to see a rheumatologist to get more powerful tablets than NSAIDS. Interestingly, the new TNF alpha blocking drugs seem to work very well for this condition if conventional drugs fail.
From David Bowden:
Claims are made for the effectiveness of "Devil's Claw" (Harpagosides, 6mg per 440 mg tablet). Have there been any clinical trials? Is it safe to take with anti-hypertensive or cardiac tablets?
From a chronic sufferer who has been unable to find effective relief.
Professor David Isenberg:
Yes
No
From Vivienne Brand:
My husband has osteoarthritis in his spine, hip, knees and hands. His doctor says there is nothing to be done except take pain killers. Is this correct, if not what should we do. Thank you.
Professor David Isenberg:
For some patients weight loss, exercise and dietary modification (lots of vegetables and fruit and cut out fatty foods) are very helpful. There is however no simple cure for osteoarthritis and painkillers are very helpful. Remember also that the pain may fluctuate quite considerably and can improve.
From Charles Marshall:
Following two or three ankle fractures some years ago, I have severe arthritis in that joint. I understand a new treatment has been pioneered involving surgical implant and bone re-shaping. I am 51, in good health and physically fit. Would I be a suitable candidate for the operation and if so, where could it be done?
Professor David Isenberg:
Yes, new ideas about this sort of problem are indeed coming to the clinic. But please try to find a surgeon with a special interest in the ankle as this sort of problem can be very difficult to fix.
From Ronald Foster:
I have excruciating pain in both shoulders, in my buttocks,(which makes it painful to stay seated for long) and in my knees and thighs, I have had this for about a month. I am 71, I have never had so much stiffness an pain. Do you think this will settle down? Or will I be like this for my lifetime? Is it arthritis? Please?
Professor David Isenberg:
Please go and see your GP as soon as possible it is highly likely that you have polymyalgia rheumatica which is likely to respond very quickly to a modest dose of steroids.
From Rhoda Manook:
I suffer from rheumatoid arthritis for periods of 6-18 months at a time, starting at the age of 18 – now I’m 24. Currently I’m recovering from a very bad bout (severe swelling in every single joint, limping, extremely tired), and find that no anti-inflammatories help – I don’t want to take steroids. Although, when I was very bad I used to take 2.4g of Ibuprofen a day and it helped significantly. The best cure, I find, is to rest, relax and de-stress – but with quite an active lifestyle this is VERY hard to do and therefore impedes the recovery time. As to the comment that one day you’re fine, the next day not – I completely agree with that, and that it’s very hard for people to understand that you’re not just taking time off, you simply cannot get out of bed.
Most people with arthritis will have a very, very clear understanding of their body and its limits. How important do you feel relaxation, peace of mind and calm is to recovery? – as I personally feel that this contributed to 80% of my recovery and was most likely a cause of my arthritis?
Professor David Isenberg:
Rest and relaxation may certainly be important to some patients, but in most cases it doesn't seem to be sufficient to relieave the considerable pain of active rheumatoid arthritis which in most cases requires quite major drugs to control and to stop the information destroying the joints.
From Cass Davies:
The joints in my fingers are swollen and lumpy. I'm 54 and this has been going on for 2 years. The doctor simply says it's arthritis, my age and I'll have to live with it. I've been to an apothecary for a year for homeopathic treatment, but there is no improvement. I've tried a Kineaseoligist for food allergies, as I'm convinced the swelling is trigured by food rather than anything else. There is a 17 week waiting list to see the local Rheumatologist, so I am embarking on my own detoxing for 14 dyas, and will gradually reintroduce certain foods. I am desperate to reduce the swellings as they are restricting my movements, and now the problem is starting in my toes. Surely at 54 I don't just have to accept 'It's my age' do I? Is there anything else you could suggest please, would acupuncture help? Many thanks in anticipation?
Professor David Isenberg:
It depends on which particular joints are affected. If its joints at the end of the fingers, you have Heberden's Nodes, which will become pain free but will remain unsightly. If it’s on the knuckles, then ask for a second opinion from your rheumatologist – it may be more serious.
From Sandra Edwards:
I have lived with arthritis for 35 years. I am now 59. Over the years I have been lucky enough to have had very good results from joint replacement of knees and hip. I am contmplating the surgical replacement of an extremely painful elbow. I have read up on the procedure, but it is a far less common operation. Can you tell me what kind of success rate has been recorded and any problems that might occur?
Professor David Isenberg:
Knee and hip replacements are very successful in short and long term. Elbow replacements do not seem to last as long and it’s very important to find a surgeon with a particular interest in the elbow to it for you.
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