Ooh about 3/4 of the people posting in this newsgroup.   I have RA and on
average your doctor has told you the truth.  The sooner your wife adjusts to
the idea the better she is going to be.   What has always been does not
matter now.   It is from today forward that counts for your wife.   Please
try to get her to read and post here where people want to help her live with
what she has because,,,,,,,, we have been there,,,, done that too.

Harv

Gary - I'm very close to your wife's age and I just started Methotrexate,
one of the first step medications which lower the immunity. It seems
counterintuitive - leave the body more prone to infection. It may even seem
'radical.' But its what the disease requires.

In RA (shorthand for Rheumatoid Arthritis), your immune system,  from some
'malfunction,' has decided that your own body is something it needs to
defend against, which is why RA is termed an 'auto-immune disease.' The body
is attacking itself. That process needs to be stopped to protect your wife's
own body. Unfortunately, one can't just stop the immune system from
attacking the body and redirect it more appropriately. Maybe one day, but
not now. All you can do is lower the total immune response so it stops
damaging the patient's own body.

At its most basic level, RA attacks the joints, causing erosions of the
protective cartilage and bone. Once that happens, the damage cannot be
reversed, only slowed (sometimes stopped) by these medications which lower
the body's immune response. In some versions of RA, other organs of the body
are attacked in addition to the joints. It can be a very debilitating
disease if left inadequately treated.

Because my symptoms have been in the 'mild' range for this disease, I have
been on the very 'mildest' treatments for about four years now, hoping that
it would be enough. I have a really excellent rheumatologist (he is the
third I tried. Finding a really excellent one is difficult). He followed a
very conservative course of treatment. Its recently been found that keeping
tabs on the condition of the hands is an excellent way of following the
early stages of RA. He has been doing an MRI of my hands every year since
the study showing this has come out.

This year, the MRI (my third) showed its first erosion. It means the
medication was not protecting my body. And my hand is now permanently
damaged. So we added the first level of these immune reducing drugs. Again,
My symptoms are pretty mild, so a really heavy hitter isn't called for
unless tests show it isn't 'enough.' Symptoms, combined with a blood test to
measure how high the body's immune response is (C-Reactive Protein goes up
in response to any inflammation in the body) tells a doctor how aggressively
the disease is acting. Medication to reduce this response needs to be as
aggressive as the body's own inappropriate activity. Everyone responds to
medication differently. It may take trying different medications, or taking
them in combination.

What your wife does now will not only affect how she is feeling now, it will
also affect her ability to care for herself as she ages: How well will she
be able to use her hands to dress, eat and toilet; whether she will need
hip, knee, or even shoulder replacements; how well she can lead an active
life on her own two feet, or from a motorized scooter or wheelchair - all
depends on preventing damage as much and as early as possible.

So, if you plan on growing old together, and you sound like a truly caring
husband, you need to think about what her life will look like all through
the course of your marriage. Encourage her to do what is truly best for her
long term health, so you can enjoy many wonderful years together.

Wishing you both all good things!
Adelle

gary, sorry about your wifes dx. She has a lot of work to do and
actually thats the good news. Ive had RA for nearly 30 years and it
wasn't that long ago there was little to research and no real options
available. Gold was available and mtx came along and that was it.
There have been some real breakthrus the last 10 years and your RD
needs to be discussing the half dozen new drug therapies available
with your wife and she needs to be reading everything she can find.
Apparently there are still RDs out there that withhold meaningful
treatment until damage occurs. It has become more common to treat RA
aggressively at the very beginning with one of the new anti-TNF
therapies in the hope of preventing all that early damage.
Unfortunately it has been found that the early damage is often the
most destructive and the longer it goes on the more difficult it
becomes to slow it down.
Good luck and encourage your wif to join the group and keep us updated
on how she does. There is a lot of wisdom and information amongst the
hundreds of folks that post and read here.

just a side note. Nearly all drugs lower the immune response. Anti-
biotics do as well as prednisone,

johnie

Sometimes you have to find a different way to say something for it to sound
acceptable.

Rather than 'lower' the immune system response, think of it as 'normalize'
the immune system response.

I come from a family that lived very long lives.  They raised most of their
very large families to adulthood in spite of epidemics of one sort or
another and in spite of much higher infant and childhood death rates around
them.

They have also left us with a kick a.s legacy of allergy and other immune
system sorts of problems.  Various sorts of arthritis, lupus, etc.  Probably
the migraines and depression as well.

When I started Methotrexate to cut down on the inflammation in my joints and
the resulting damage, I was surprised to find it was also a wonder drug for
my asthma as well.  A well known result, just has too serious side effects
to be standard treatment for asthma.

You really don't want to know how many poisons I've consumed over the years
to keep my "healthy" system in check.

Jo

DMARDs -- Disease Modifying Anti-Arthritic Drugs -- are an excellent way to
combat arthritis.  They don't stop the disease, they don't cure any damage
that's already been done.  NOTHING CAN DO THAT.  But they can slow down the
progression of arthritis.

NSAIDs -- Non-steroid Anti-Inflammatory Drugs -- help reduce inflammation
and pain.  Reducing inflammation reduces damage to the body's systems.

But don't forget low impact exercises -- water exercises, walking (not
jogging or running).  I even added square dancing and lost pound after
pound.   That's another thing - keep the weight down because every extra
pound on the body damages it, especially in people with arthritis.

When I was diagnosed in 1976, there were only aspirin and Indocine (now
available OTC in non-prescription strength generic formulas), gold, and a
couple other remedies.  Today there are dozens and dozens of drugs.  Not all
work for everyone, and when they do work not all are effective beyond a few
years at which time a person must switch to something different.

By the way, I was always healthy before arthritis hit me.  I had 23 years in
the Naval Reserve (and I was able to complete 26 before retirement), high
desert camping and hiking.  I had been a cop for 10 years before trading my
badge for one from the fire department in the same city.  Diagnosis came 1
year later with a 20-pound lifting and carrying restriction and I moved into
administration for the next 12 years before retiring on disability.

... Epitaph:      ANGELA LANSBURIED HERE