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Disease-related, profound fatigue impairs the quality of life of many people with rheumatic and musculoskeletal diseases. A Belgian study (1) has now concluded that early intensive treatment combining methotrexate with a bridging scheme of prednisone can reduce the onerous fatigue – this also applies to patients at low risk of a severe course. The European League against Rheumatism (EULAR) therefore recommends, that even in so-called low-risk patients, early consideration should be given to whether intensive treatment should be initiated.
Patients with rheumatoid arthritis (RA) suffer from chronically inflamed joints. The inflammatory processes in the body can lead to a feeling of weakness, exhaustion, and lassitude – this abnormal tiredness is called “fatigue”. Such fatigue is poorly helped by resting and can accompany patients constantly or at least over long distances.
“In addition to pain, profound fatigue reduces the quality of life for many people, even more than the swelling of the joints”, explains EULAR President Professor Dr. Iain B. McInnes from Glasgow, Scotland, UK. However, doctors often do not pay sufficient attention to this fact and do not adjust the therapy accordingly.
A recent Belgian two-year study has now examined the question of whether early intensive treatment of RA directly after diagnosis has a positive influence on the course of the disease and offers an opportunity to manage the fatigue. Using the same approach, it also examined whether these mechanisms also apply to patients who have a lower risk of a severe disease progression.
“Up to 90 percent of patients with rheumatoid arthritis report profound fatigue,” says Dr. Diederik De Cock, Katholieke Universiteit Leuven, Belgium, who conducted the study together with his team. Fatigue has a major impact on patients’ lives and is perceived by many as difficult to manage. “The early course of the disease could provide an opportunity to manage fatigue.”
Eighty patients with a low risk profile were selected for the study – this risk profile is based, among other things, on a low disease activity status. Randomized into two groups of 38 and 42 patients, the subjects received, directly after diagnosis of RA, monotherapy with 15 mg methotrexate weekly or a combination therapy of 15 mg methotrexate weekly plus cortisone (prednisone) starting at 30 mg but tapered weekly to 5mg. Methotrexate suppresses the disease and acute inflammatory reaction, while prednisone has a strong anti-inflammatory effect and is suitable for reducing pain and inflammation of the joints very quickly.
The result: Patients who received intensive treatment with the combination therapy of both drugs for two years were less tired than the patients in the monotherapy control group – even though the disease activity in both groups were comparable over time. The levels of fatigue seemed to differ more and more over time between groups.
“This underlines the importance of initiating optimal, intensive treatment early on, even in so-called low-risk patients,” says EULAR Scientific Chair of the Congress, Professor Dr. John Isaacs from Newcastle University, UK. Unfortunately, this is not yet standard practice. The study clearly shows how fatigue levels in early RA can be significantly improved, the congress president concludes. About one percent of all people worldwide suffer from rheumatoid arthritis – according to figures published by EULAR in the run-up to its annual congress
Rheumatoid arthritis
Welcome to the first in an ongoing series of blog posts into the signs and symptoms of rheumatoid arthritis. This in turn is part of an informational series which we hope over time with cover the main issues associated with rheumatoid arthritis.
One of the reasons I want to cover this area in more detail is that my grandmother suffered from Rheumatoid Arthritis for many years. Her life, I believe, could have been much easier if there was greater awareness of the realities of RA.
As you may know the symptoms of rheumatoid arthritis come in to three main categories: –
a) Symptoms affecting the joints,
b) Systemic symptoms or those symptoms which impact the whole body
c) Other symptoms affecting specific organs.
Today we will focus our attention on joint symptoms. Which are the most common symptoms (and indeed sign) of rheumatoid arthritis or RA; as it is often called.
Just by way of information a joint id defined in the Oxford English Dictionary as “A structure in the human or animal body at which two parts of the skeleton are fitted together.”
The most common symptom of rheumatoid arthritis is stiff painful and swollen joints. Typically these develop over time in joints on both sides of the body. In many cases the joints of the hands or feet are affected first. Often other joints are affected which include knees, elbows, wrists and shoulders among others.
The pain caused by rheumatoid arthritis is often described as “deep and aching”.
Often at its worst after periods of rest (i.e. after a long drive or waking from sleep). It can be helps by gently moving the affected joint. Disrupted sleep is common in people with RA because of regular waking due to pain. This is one of the causes of fatigue in RA patients.
In the morning, after sleep, the affected joints can also feel very stiff. This may last for some hours after waking. The time that the stiffness lasts is often used as an example of the difference between RA and osteoarthritis.
The joint inflammation means that they, the affected joints, become “swollen, red and hot”. As RA progresses both cartilage and bone are destroyed. This again limits mobility and in many cases leads to deformities.
One of the aims of blog posts like this is to give our readers the opportunity to share their stories and learn from the experiences of others in the rheumatoid arthritis community! To facilitate this it would be great if you would use the comments box below to talk about the symptoms and signs of rheumatoid arthritis. You might care to think in terms of the following questions:-
a) Have you been diagnosed with RA? For how many years have you been diagnosed?
b) What were the first signs of rheumatoid arthritis?
c) What are now your main symptoms?
d) What one piece of advice would you give to somebody who think they may have RA?
Thanks very much in advance.
