Rheumatoid arthritis patients have been on a roller coaster the last couple of years. Their potentially debilitating disease still remains mysterious, and promising treatments have turned out to have serious side effects.

Unlike osteoarthritis, which is associated with aging and mild inflammation in several joints, rheumatoid arthritis affects the entire body. It can affect children (juvenile RA) as well as adults.

Joints are attacked by the immune system and without intervention can become gnarled and crippled. People can experience aching muscles, anemia, exhaustion, fever and nerve damage.

A few years ago, an entirely new class of high-tech medicines was introduced. Enbrel, Humira and Remicade are injectable medications that alter the course of RA. These drugs keep a natural immune system compound called tumor necrosis factor (TNF) from starting a cascade of events resulting in joint destruction.

For many patients, these anti-TNF drugs have revolutionized treatment by relieving symptoms and restoring the ability to move without pain. But such relief comes at a cost. These medications are very expensive and they may also have worrisome side effects.

TNF plays an important role in the body when it comes to fighting infection. By blocking TNF, these medicines can increase the risk of tuberculosis and several other serious infections.

Concern has been raised that such drugs may worsen heart failure or multiple sclerosis. There is also controversy about their role in the development of lymphoma, a cancer of the immune system.

Another group of medications that was supposed to relieve joint inflammation is the COX-2 inhibitors. RA patients were happy to learn about Celebrex, Bextra and Vioxx because regular use of high-dose conventional anti-inflammatory drugs like aspirin, ibuprofen or naproxen can lead to bleeding ulcers.

But the evidence that these medicines can increase the risk of heart attacks or strokes has dampened enthusiasm for them. This has left RA patients looking for alternatives. Some are returning to old-fashioned approaches. One reader shared the following thoughts:

“I do not understand why you ignore an alternative remedy my rheumatologist uses. I have rheumatoid arthritis, and for nearly twenty years she has been giving me, at five-week intervals, an injection of the gold solution myochrisine. I also take small daily doses of prednisone and methotrexate.

“I have a blood test and urinalysis each time I get a shot. So far, there are no bad effects, and I am quite mobile and pain free. Why do people ignore an old remedy that works so well, apparently just because it’s old?”

Gold shots have been available for more than 70 years. Not everyone can tolerate gold because it can cause an itchy rash, mouth ulcers and more seriously, kidney damage. But some patients, like this reader, do surprisingly well. Gold salts are also available in an oral formulation (Ridaura).

Given all the disappointing news about the COX-2 inhibitors, it makes sense for doctors treating RA patients to consider all the options and not just the latest, most heavily advertised products.

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