Saturday, March 6, 2010

Another article on RA

Hopefully this will help too.

Rheumatoid Arthritis Treatment, Work Disability and Employability

The pain, fatigue and limited mobility associated with RA affect all parts of a persons' life, especially the ability to work productively. Several studies in the past few years have shown that people with Rheumatoid Arthritis tend to have a much higher rate of functional limitation in work activities, use more sick days than people without rheumatoid arthritis and have a high rate of unemployment due to disability.

Two studies published this month in the journal Arthritis Care & Research discussed work disability or employability in people with RA.  In one large study, researchers tried to study work disability over time. The study included over 5,000 people, ages 19 to 64 with disease duration from one year to 20 or more years.  The study also looked at data about the type of employment and, if unemployed, whether subjects were retired, homemakers, students or were disabled.  Overall, the study found that while 85% of the subjects were employed at disease onset; as disease duration increased, so did the proportion of subjects who were not employed (in other words,  the longer people had rheumatoid arthritis, the less likely they were to continue working).  For example, 23% of subjects with 1 to 3 years disease duration were not employed (35% for those with 10+ years and 51% of those with 25+ years).  The researchers found that much of this premature work-cessation was arthritis related. 

Newer Treatments Help People with Rheumatoid Arthritis Keep Working
However, the researchers were careful to note that the prevalence of rheumatoid arthritis disability has generally declined in the past 15 to 20 years.  They also found that many of the cases of work disability were temporary, with people later returning to work.  The study suggested that the earlier availability of more potent drugs or the use of combinations of drugs might be a factor.  They also cited the national unemployment rate trends over time and the decline in physically demanding jobs as possible factors. 

RA Patients More Likely To Keep Working If Treated Early
The second study focused on employability outcomes for patients in two ongoing studies of patients being treated with a combination of infliximab and methotrexate (MTX).  "Employability" was reported by the patient, based on whether they felt well enough to work if a job were available.  This study found that participants with early onset disease who had not previously taken MTX were four times more likely to become employable with longstanding rheumatoid arthritis that had previously not responded as well to MTX, but had a better response to infliximab plus MTX.  This finding was consistent with the findings of other studies that emphasize the importance of early and effective treatment of rheumatoid arthritis.

I was particularly interested in these articles because I find that most attention or discussions about arthritis in the news deals with new drugs or the effectiveness of drugs.  It seems like much less attention is paid to how arthritis affects our lives and how we can manage those effects.  When I think about my own experience with RA, I think it definitely affected my jobs and career choices in some ways.  Even though I have relatively mild/moderate disease activity, I have had RA since I was a toddler and I do have longstanding joint wear and some deformities.  I have also found that there are certain jobs that I shouldn't do.  For example, I worked at a couple retail jobs in college and graduate school.  At each one, I stood for most of my shift, 4 to 8 hours and was not allowed to sit on a stool, even while working the register.  By the end of the day, my hips, knees and feet were very stiff and painful.  Eventually, my knees would flare and get extremely swollen.  I tried to wear knee braces, which helped stabilize my knee, but didn't stop the swelling or pain.  I would occasionally have to have one knee aspirated and injected with steroids.
Now, I work a desk job that requires long hours typing on the computer.  My knees still get stiff from sitting, but I move around a lot and I prop up my feet on an empty copy paper box under my desk.  Since my arthritis is most active in my hands now, the typing and mouse clicking can be the most painful, so I switch the mouse between hands.  I also have recurring bouts of carpal tunnel syndrome, so I sometimes wear a splint at work so help ease the pain.

How has arthritis affected your ability to work?  Have you changed jobs or careers because of it?  Are there any accommodations or modifications that you've made that have you have found to be helpful on the job?  Please share your experiences.

When I last wrote about RA and work, I listed some suggestions from the Arthritis Foundation and about managing RA at the workplace.
In addition, the Arthritis Foundation has an interesting page on their website devoted to arthritis in the workplace including tips for job searching, work relationships and whether and how to tell coworkers about your arthritis and several articles with personal advice.

An article regarding RA nightmare!

This is one of the article found in the internet which was not very encouraging.  Please read.

Hello to everyone! I hope New Year brings you all some relieve, happiness and health to you and your families!

I was Dx with MS and RA this summer. I went to so many RA Drs. who couldn't dx me on time causing more and more damage to my body. Finally I was lucky enough to meet this wonderful DR at HSS in NYC, who was very surprise that it took me so long to see medical attention. Not my fault. She even apologized for Drs who did not see such obvious symptoms.

Well, every joint in my body by now affected by RA. Not only joints though: I have torn tendons, teared muscles and ligaments due to RA in both elbows, shoulders, neck, knees, ankles and so on. This is extremely painful condition and surgery required to fix it, but my RA doesn't let me to go through more surgery right now since it may not heal properly due to inflammation in a body.

Dr said that my treatment has to be very agressive, and put me on Prednisone, Meth, Rx Folic Acid and now i had my blood work to check for TB to be able to start Enbrel.

I have to say that Meth makes me very tired, i am constantly exhausted, nausea, no appetite at all, I loose my hair (as you know Meth is low dose of chemo therapy). But pain is still here and the most wondering thing is: my C-Reactive Protein is still high. How this can be? Meth is working on bringing my inflammation down, is in it? I take 20mg of it (8 pills once a week) and Prednisone (5mg right now once a day, before was on 40 mg). So I have problem to understand what is going on?

Dr thinks I will have to be on Meth and on Enbrel together and no time limit to it. She says that if we stop the treatment, damage will continue. This means I have to be on it for the rest of my life? How many month/years are you on this type meds?

I have to say that I always been very optimistic person, full of life, happy person. I had 2 major spinal surgeries in '06 and '07. My "progress" report is - Failed. Despite this I still was very optimistic and happy person.
Since I went on Meth - i feel like I want NOTHING. I don't eat, nothing really makes me happy, exhausted 24/7, I don't care how I look anymore... sounds like depression, right? But I never been depressed in my life, why now I am feeling this way? Does anyone here has same side effects from Meth?

I am on Pain meds since my first surgery 24/7, but it never affected me at all. Since I am on Meth, i am not myself anymore. This is not the way I ever leaved or want to leave. Please, share your experience with me. I would like to learn more about treatments for RA first hand and also how you all react to treatments. Your progress, or your disapointments..

My own Experience on RA night mare cont..... -Rheumatoid Arthritis

Story of RA continue.  It was the worst attacked after end of 2008.  The pain is so much with the swollen and fever every night causing no work can be accomplished.  Time to rest more.
Later, getting the Chinese herbs previously given but not taken due to CNY.  Also try on another new product which cost RM138 in market with the name of Intra.  The night seemed to be better, at least the sleep is not disturb and the pain is so much less.  However, not sure which one is helping but why bother as long as the pain is not there so much.  Still having stiffness in the morning.  The swollen still stay, so need to do something about it.
So far, have been trying other product other than the western medicine such as the Alpha Lipid which cost RM180 in market; the Chini product of Chinese herbs with the long wave magnetic chair and Chinese herbs which is really expensive and needed more timing;  and the recent product is Intra the fruit juice which is so much easier even though expensive.  However, none cure the swollen, just ease down the pain which is good enough for me at the moment. Well, end up dig out some of the previous western medicine kept as need to keep the swollen at bay.  Taken one tablet of diciofenac sodium for swollen purpose, later will take 5 tablets of methotrexate sodium to stop it.  All these medicine was used earlier for RA and also mentioned in a magazine(long life) which help me to take it.  The article was a good one as it detailed out the problem and what will you encounter in the coming years.  Guess will photostat and distribute to people that need to know.

Let's look at what is in the article I mentioned above.  It was in mandarin by Dr. Gun Suk Chyn regarding burden of RA & advances in treatment of RA in Malaysia.  The reason to the RA cause are first, immune system problem.  Secondly, abnormal immune system attacking own healthy tissue and parts as it treat it as the enemy.  The redness and pain was cause by the attacking of immune system to the synovium tissue.  This will cause the abnormal synovitis grow and unusual divided, thus causing abnormal shape and position moving away which in long term cause paralyse. It will also weaken and damaged the soft bone and the flesh, muscles around.  So, RA can cause paralyse in future as all the joint will be in odd shape and can't function in normal.  Even the normal routine such as holding the spoon, tooth brush or comb.  It's quite true as went through the experience when the stiffness occurred in the morning for a short time.
The age for RA is for those between 30 to 60, previously it was said 40 and above.  Looks like the younger people will be getting it too now.  Women are said to be more than men and the ratio is 3:1.  It was mentioned that the first two years, 50% will encounter tighten fingers and stuck together.  After 10 years, 50% will be paralyse.  You will also die earlier, 10years earlier for women and 4 years for men.
The symptoms are pain, swollen, felt feverish at the joint, having fever, lost of weight and tiredness.  Usually it will affect a pair of organ in the body such as the palms, the legs, the knees and the wrist, especially the hand and legs small joints.
What you will encounter in your life after RA?  Well, less work day, always on MC, earlier retirement, having economic problem, lost your job and depression.  There are people who have RA due to genetic cause call HLA-DR4 and will pass to generation.
Medicine use usually Nsaids for pains. For swollen will need paracetamol, acetaminophen, priroxicam, dicofenac, ketoprofen, celecoxib and etoricoxib.  As for slowing down the RA, use Glucocor-Ticoids and Prednisone and especially when attack is ativated.  Other choice, taking Methotrexate.  It was said taking Anti-TNF-ALFA such as Adalimumab and Etanercept Infliximab will help to stop the joint from damage.
If RA not treated properly, it will cause paralyse earlier.  Another bad news, it cannot be cured, but needed to stop the swollen, pain, slow down the proses of damaging to the joints.  Even if the sign of RA not obvious, the RA will still attacked silently, your joints!

Hopefully, the knowledge regarding RA is clear.  However, how to avoid RA was not mentioned.  But the reason to it in my experience is not to let your immune system weaken.  Some said usually RA happens after surgery, when you are very weak(such as after abortion or serious sickness) or even depression which means your immune system also weaken. 
So, we will need to make sure our immune system not weaken or we will need to face the worst of all, RA! Guess people without RA will need to be happier and make sure their immune system are strong most of the time if wish to avoid RA nightmare.  Some said go for meditation, yoga and be more positive in your life or enjoy your life to kick away all the stress nowadays. All the best to the ones without RA!