For a while, Doreen Belyea’s life was rosy. She had a young family, she and her husband, Jay, had good jobs, and they had just moved into a new house in Saint John, N.B. Then in May, 1993, the pain started. At first it was only Belyea’s feet—they would swell and cramp. Sometimes, if she took off her shoes, she could not put them back on again. “I went to the doctor and he told me I was wearing cheap shoes,” says Belyea, now 30. New shoes did not help. Flu-like fatigue followed. Sometimes her hip would go out. She thought it might be a pinched nerve. By September, she was in severe pain. Her hands were swelling and her doctors had no definitive answers. Finally in November, a blood test revealed that Belyea had rheumatoid arthritis, a chronic disorder in which the body’s immune system attacks healthy cells in joints. “My whole life has changed in the past three years,” she says. “It’s been devastating.” Arthritis is not for senior citizens alone. True, if people are 65 years old or over, their chances of getting arthritis are about 10 times higher than they are for someone Belyea’s age. But in terms of sheer numbers, more than 60 per cent of Canadians with arthritis are under 65. In addition, fully 4.6 million Canadians of all ages are estimated to have one of the more than 100 forms of arthritis. And with each passing decade, another million will be added to the total. By the year 2026, almost one in five Canadians are expected to have some form of arthritis. And in the face of those disturbing numbers, researchers are struggling to find new and better treatments in the areas of anti-inflammatory drugs, gene therapy, ultraviolet light therapy and so-called smart drugs, which can target specific body chemicals.
The trend, says Dr. Edward Keystone, chief of rheumatology at Toronto’s Wellesley Hospital, is towards treatment that acts with the precision of “smart bombs and guided missiles. We’re changing the nature of warfare.”
What is arthritis? The term covers a wide range of illnesses, including lupus, osteoarthritis, bursitis and gout. The cause of arthritis
is unknown, though some scientists think it may be linked to some as yet unidentified infectious agent. What is known is that it is an autoimmune disorder: the body’s natural defence mechanisms—designed to ward off the likes of bacteria, viruses and cancer—actually start attacking healthy parts of the body. This overzealous onslaught by the immune system can damage the protective lining of joints, leading to swelling, pain and bone destruction.
In the past, arthritis has been treated with drugs like Aspirin, Motrin and Naprosyn. While these drugs continue to be used as a first-line defence, and have been proven to be beneficial in the treatment of virtually all forms of arthritis, they do not prevent the progression of the disease. They can also have undesirable sideeffects. These drugs fall into a class known as nonsteroidal anti-inflammatory drugs, or NSAIDs. But NSAIDs can be a double-edged sword: while their effectiveness against arthritis lies in their ability to block the activity of prostaglandins, which are chemicals linked to inflammation, prostaglandins are also a necessary part of the body, protecting, among other things, the stomach lining. As a result, the possible side-effects of NSAIDs include ulcers, which can, although rarely, result in death from internal bleeding.
But studies in rats by Dr. John Wallace at the University of Calgary, in conjunction with the University of §| Naples, have already led to experimental NSAIDs with
estern medical research into arthritis may soon have competition from the burgeoning field of Eastern alternative medicine. In October, Dr. Wah Jun Tze, a pediatrics professor at the University of British Columbia, will oversee the opening of the Tzu Chi Institute for Alternative and Complementary Medicine, where researchers will apply Western analytical standards to the study of alternative medicines and treatments for diseases like arthritis, cancer and AIDS. The institute will be established with $6 million donated by the Tzu Chi Foundation, a
Buddhist charity, and will be affiliated with the Vancouver Hospital. Traditional Asian therapies for arthritis, such as acupuncture and Tibetan herbal baths, are just two of the treatments being considered for in-depth study at the new institute. “The institute is trying to put together something credible that eventually will be introduced into mainstream health care,” Tze says. “We hope to bring on some of the age-old therapies which are effective, properly controlled and standardized, rather than relying on so-called snake-oil salesmen.”
research points to effective treatments
gentler side-effects. These new NSAIDs release nitric oxide, which stimulates blood flow and healing in the stomach. “Adding the nitric oxide doesn’t interfere with the ability of the NSAIDs to block prostaglandins,” Wallace says. Adds Keystone, who is also the national medical spokesman for The Arthritis Society: “The word on the street is that it looks very promising.” This fall will also mark the first major international trial for a new generation of NSAIDs that target only the prostaglandins in the joints.
Biotechnology may also lead to viable treatments for arthritis. Several researchers have noted that the joints of patients with os-
teoarthritis produce more interleukin1—a key component in the body’s immune system—than those of patients not afflicted with the disease. Scientists have since discovered a gene capable of blocking interleukin-1, which genetic engineers have piggybacked onto a harmless virus and then injected directly into diseased joints. Tests in rabbits have shown that with the help of the virus, the gene inserts itself into cells lining the joint, where it begins to produce blocker proteins to curb interleukin-1. To date, though, that treatment, while effective in suppressing arthritis in rabbits, is shortlived. And without further refinement, gene therapy for arthritis will likely have to be limited to forms of the disease that attack only a few joints—the thought of injecting blocker genes into the more than 60 joints typically attacked by rheumatoid arthritis, for example, is at the very least an unpalatable prospect.
An alternative may lie in the development of smart drugs. For one thing, scientists have established that the hormone TNF figures prominently in the development of many forms of arthritis, particularly rheumatoid arthritis. “There are several preliminary studies that suggest that you can in fact dramatically improve patients with rheumatoid arthritis if you reduce the level of the TNF hormone,” Keystone says. This fall, a Canada-U.S. team plans to test the potential usefulness of a new drug to block TNF. Ultraviolet light, meanwhile, is part of one of several treatments being tested for their therapeutic potential. In one recent study conducted by an American pharmaceutical company on only a handful of patients, the drug methoxypsoralen (trade name Uvar) was absorbed by overactive cells of the immune system, making them sensitive to ultraviolet light. Exposure to the light then inactivated the cells’ negative effects. Last month, Keystone began a larger and more comprehensive six-month study with 50 patients to determine the prospect of further use for Uvar.
But until some of these new studies result in bona fide breakthroughs, patients like Belyea will have to make do. She has to take 74 pills every week. Her pain and fatigue have forced her to leave her job as a secretary and switchboard operator. With one income gone, the family has had to rely more heavily on Belyea’s 33year-old husband, Jay, a commercial photographer. And, naturally, she worries about the future of her son, Matthew, 8, and her daughter, Rebecca, 4. Fortunately, she says, arthritis societies provide support groups and “self-management training” to help sufferers deal with pain, fatigue and depression. Belyea listens to relaxation tapes in order to lower stress—a factor that some doctors think can aggravate arthritis. ‘You could say it’s been hell,” Belyea says. ‘You realize how lucky you were before all this happened.” With a bit of good science, her luck could change yet again. □
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