Baton Rouge Clinic Health Library

Myths in Rheumatology

     Published: 08, 2009

Of all fields of medicine, Rheumatology and arthritis care seems fraught with myths and confusion more so than others. From old remedies to high tech biologic agents, rheumatologists and patients must sort through a wide range of options of care. Every year there are more medications available, but some of the old opinions continue. There are innovations in the field on a regular basis that warrant discussion and old items to ponder which we can address with a grain of salt (or perhaps 5 grains of aspirin).

Myth No. 1 – “You have to live with it”. – Before we talk about medications, we should recognize that “adapting” to arthritis may require physical therapy, and stress or pain management in an active approach; a passive acceptance or “sentencing” of arthritis makes all efforts more difficult. There are medications that are more protective available and rheumatoid arthritis as “crippling arthritis” is a thing of the past. Earlier diagnosis and earlier treatment is critical.

Myth No. 2 – “You should treat your arthritis with diet” – There are no particular foods that consistently treat arthritis, but overweight is definitely an aggravating factor! Too much weight definitely hurts the back, knees, and feet. However, the exception is in the particular case of gout, where dietary avoidance of substances called purines in certain fatty foods is indeed a major factor and is the key toward treatment. The dietary supplement glucosamine may help osteoarthritis, but other supplements are more doubtful.

Myth No. 3 – “There is really nothing new for arthritis, is there?” – Fortunately and definitely this is not so. There have been remarkable advances in the last several years in our use of biological medicines employing antibody and protein therapies. The anti-TNF medicines are innovative medicines against the destructive enzyme “tumor necrosis factor” (an archaic name since it has nothing to do with tumors). Remicade, Enbrel, and Humira are the main members of this group and are used to treat primarily rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. These agents have good protective value as well as providing symptomatic relief of pain and swelling. Two new agents, Simponi and Cimzia have been introduced this year, and we now have options of dosing which range from once a week to once every two months, some by an injection pen and others by butterfly needle, and fusion. Other agents are being developed to attack other specific destructive enzymes or cytokines to protect joints.

Myth No. 4 – “There are several types of arthritis” – Actually, there are more than 100 types of arthritis recognized by The American College of Rheumatology, of which all six rheumatologists at The Baton Rouge Clinic are members.

Myth No. 5 – “Fibromyalgia is untreatable and incurable” – Fibromyalgia is a pain perception illness causing ongoing discomfort in muscles, particularly the shoulders and back, poor sleep, and fatigue. Like most areas of medicine, “treatment” is more attainable than “cure” (i.e. treating high blood pressure with anti-hypertensives as an example). In the last year there have been three agents approved by the FDA, Food and Drug Administration. These agents affect the pain pathways including serotonin and epinephrine, and with a regimen of exercise and proper sleep, can make a sizable difference in the quality of life of individuals with fibromyalgia.

Myth No. 6 – “Rheumatologists treat mainly rheumatoid arthritis” – A main challenge of rheumatology is in deciding what type of arthritis is affecting the muscles and joints, be it inflammatory or degenerative. Osteoarthritis is the most common, but lupus, Sjogren’s syndrome, ankylosing spondylitis, and gout can also be mimicking types of arthritis. Joint and muscle pain can be due to a dietary deficiency of Vitamin D, underactive thyroid in hypothyroidism, nerve pain in B12 deficiencies, and in cancer related para-neoplastic syndromes, to name a few.

Myth No. 7 – “Steroids are bad for you” – Too much steroid is definitely bad, but proper doses are central in treating lupus and certain types of autoimmune lung disease and vasculitis, inflammation of blood vessels. “A pinch, not a pound” of steroids is a good starting point.

Myth No. 8 – “The side effects of arthritis medicines are worse than the cure” – When considering use of a medication we must weigh the risk of the medicine versus the damage potential of the untreated disease, especially with our biologic agents. Even OTC, over-the-counter medicines like Ibuprofen and Naproxen can, in some cases cause ulcers and fluid retention and should be discussed. Acetaminophen, while generally among the safest medicine for arthritis, can cause liver damage in excessive amounts, particularly mixed with alcohol. The FDA is considering new labeling in reducing the daily maximum from 4000 mg. to 3250 mg.

Myth No. 9 – “Generics aren’t strong enough for arthritis” – We still get a lot of mileage out of using Methotrexate and Plaquenil or hydroxychloroquine (generic name) which have remained cornerstones of treating rheumatoid arthritis and lupus for thirty years. Generic NSAIDS, non-steroidal anti-inflammatory drugs, when taken properly have similar efficacy to brand names; tolerability among individuals vary however.

Myth No. 10 – “It is out of my control” – Remember, there are always options. If the knee wears out despite medicines, weight loss, and visco-supplementation knee injections or perhaps joint replacement is an option for you. If the pain to the back worsens, perhaps an epidural steroid injection can help. If overall pain worsens, there are specialists in pain management. If the weight will not come off, there are dietitians.

Finally, Non-myth No. 1 is that resourcefulness and perseverance with a doctor and patient working together is the key.

The Baton Rouge Clinic, AMC, offers this information as a courtesy service. Please remember that medical knowledge is always evolving and we cannot represent that any of our information is absolutely current. Please consult a physician before taking any medical action based on information gathered from this or any website.