Aging Gracefully with a Chronic Disease

As rheumatoid arthritis patients grow older, they face new challenges of managing the incurable condition, a University of Michigan doctor says.

For the better part of three decades, Sherrie Kossoudji has endeavoured each day to manage the inflammation, chronic pain, tight joints and other types of physical strife caused by rheumatoid arthritis.”Rheumatoid arthritis affects my life in as many ways as you could possibly imagine, and pretty much at all times,” says Kossoudji. “It is a disease that can be manipulated with medicine, but it doesn’t ever really go away.” Now 53, Kossoudji is dealing with a new aspect of her chronic disease: sorting out what is a normal part of aging, and what is a facet of rheumatoid arthritis, or RA. If she has a sore leg, a pain in her elbow or a kink in her wrist, is it because of RA or is there another cause?”I have fingers that don’t work well, joints that don’t work well. I have a wrist that doesn’t flex and neuropathies in my legs,” she says. “I think it’s difficult when someone has a long-term disease to separate what happens as the body ages from what happens when you have a disease for a very long time.”RA is debilitating for some patients as they age, so it is especially important for people with RA to see a rheumatologist to determine the best course of treatment and to gain the best possible understanding of what is happening in one’s body, says David A. Fox, M.D., division chief and professor of rheumatology at the University of Michigan Health System. Fox is Kossoudji’s rheumatologist. Whatever the age of the patient’s RA onset – whether it is at a young age, like Kossoudji at the time of her diagnosis, or later in life – Fox emphasizes that RA is not a normal part of aging. It is a specific condition with symptoms that can’t be cured, but can be managed.”Arthritis should not be considered just a part of the aging process or a normal part of getting older,” Fox says. “There are some elderly people who don’t have arthritis, and many people who develop arthritis when they are younger.”Many patients are helped by some of the available treatments, including pain relievers and anti-inflammatory medications known as nonsteroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs, such as methotrexate and tumour necrosis factor (TNF) blockers. Exercise, weight loss and diet changes also can be helpful, Fox says.RA is one of more than 100 varieties of arthritis, a wide-ranging set of conditions that affects 70 million people in the United States. RA involves a malfunctioning of the immune system that causes inflammation in the lining of the joints. With time, the cartilage and bone are attacked and invaded, Fox says, to the point that the structure of the joint can be destroyed. This can lead to deformities and disabilities.”Patients may develop inflammation in their lungs or peripheral nerves, inflammation in the salivary glands or tear glands that prevent them from functioning normally, and they may become what we call ‘systemically ill’ – that is, the disease can affect the patient’s body as a whole,” he says.One very important thing that Fox tells his patients with RA is that they do not have to stop living their lives. Kossoudji, for one, has followed the advice. “My job is to make sure that rheumatoid arthritis diminishes my life as little as possible,” she says. “My goal is not to overcome the disease, but to do my best at managing the disease.”(Source: Katie Gazella : University of Michigan : June 2007)