DEAR DR. DONOHUE: I developed rheumatoid arthritis four years ago. I am still working, lifting 70 pounds and pushing up to 150 pounds in a handcart, and I work 10 hours a day. I had been on methotrexate, but it made me sick. Then I went on hydroxychloroquine. Next was Enbrel, and now rituximab. I am a 47-year-old woman and have worked 22 years at my job. My insurance company is denying me coverage for rituximab because I don’t take methotrexate. So I have hit a wall. People tell me to write to you for a cure. Is there one? — G.G.
ANSWER: There isn’t a cure for rheumatoid arthritis, but so many newer treatments exist that control of it is possible for most patients. Rheumatoid arthritis is the less common kind of arthritis. It usually strikes between the ages of 35 and 50, and more women have it than men.
Rheumatoid arthritis, unlike osteoarthritis — the common kind of arthritis — is more than a joint disease. It’s a systemic disease. That means the entire body is affected by it, and many organs can be involved — the lungs, the lung coverings, the heart, blood vessels, eyes, spleen and bones. Systemic symptoms include fatigue and weakness. The hands, wrists, knees, feet, elbows and neck are the joints most affected. They become swollen, red, hot, painful and often deformed. The goals of treatment are relief of pain, reduction of inflammation, stopping joint destruction and maintaining joint function.
There are some things you can do on your own. Exercise is important, but your job calls for exhausting physical labor, something that’s not good for rheumatoid arthritis. Will your employer switch you to another position? Rest stops the stress on joints. You can try taking omega-3 fatty acids, found in fish and obtainable in pills. It has helped some.
Nowadays, the trend is to start rheumatoid arthritis patients on the most powerful drugs so joints don’t become permanently damaged. You have taken some — methotrexate and Enbrel. Rituximab (Rituxan), usually combined with methotrexate, has been quite effective for rheumatoid arthritis that’s unresponsive to other medicines.
Perhaps your insurer will reconsider its position with a letter from your doctor explaining why you are not also taking methotrexate.
The arthritis booklet deals with osteoarthritis and rheumatoid arthritis. Readers can obtain a copy by writing: Dr. Donohue — No. 301W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I have glaucoma. I use eyedrops daily. Does caffeine cause eye pressure to rise? — A.G.
ANSWER: Glaucoma comes about from a rise of fluid pressure in the eye and from damage to the optic nerve at the back of the eye. Lowering fluid pressure — often with eyedrops — preserves the optic nerve and vision.
Caffeine can slightly raise eye-fluid pressure for a limited amount of time. I would stop using it until I saw my doctor again. Then I would question the doctor, who can determine if the rise of pressure would be significant for you.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.
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