Chances are, you have heard an inspirational song featured in a movie about a person overcoming impossible odds. My son would invariably rent movies like this time and again. By the sixth or seventh time, I would point out that he could have easily purchased the DVD and saved gasoline, travel time and money to boot. Similarly, when our patients come to us for information and reassurance constantly, it may be wisest for them to become their own champion with the health care professional as their facilitator.

Last fall, I had the distinct honor to speak at the first Annual Diagnosis Arthritis Symposium in Philadelphia. At this conference, I met Amye Leong, a motivated young woman with arthritis who is an inspirational speaker and author. Her story was one I had rarely heard. At one point, she was in a wheelchair and her condition was slowly deteriorating. Then at a pivotal doctor visit, Ms. Leong proclaimed that she no longer wished to be tethered and wanted to walk again. Evidently, her physician was shocked as he said he did not have a clue of her goals and concerns. Then Ms. Leong stated, “You never asked me.”

Many patients with chronic diseases expect us in health care to make their decisions for them. Although one might think this is a phenomenon among older people, young patients do this as well. I often tell these patients, “You are the expert-in-training. You must also research the available options and decide what is best for you.”

Think about it. Patients with diabetes, for example, need to check their blood glucose level measurements or be aware of their hemoglobin A1C. Asthmatics benefit from peak flow meters and self-adjustment of medications and lifestyles. While cardiac patients are medically monitored, they are still encouraged to choose their personal rehabilitation programs.

Facilitating The First Steps To Patient Involvement
When a patient first comes to our office, we review his or her history, assess laboratory and radiographic studies, and determine the diagnosis.1,2 Setting the stage for future therapies is most advantageous at this time. It is also a time to determine the patient’s desire and ability to participate in physical activity, and whether the patient can afford the prescribed therapies and medication. With patient assistance programs, financial help may be available but it is better to do the research earlier than later.

A good first step to take for patients and health care professionals is joining the Arthritis Foundation (www.arthritis.org). For those who do not have a computer or do not have access to a nearby library or college IT center, they may call the general toll-free number (800) 568-4045.

It is important for patients to take the lead when it comes to their own health care. Charlene Morris, MPAS, PA-C, says a good first step is joining the Arthritis Foundation.

On the Web page, anyone may access disease specific information, sign up to receive Arthritis Today or join message boards and read personal stories from people just like us. When I received the recent request to renew my membership with the Arthritis Foundation, I was delighted to see that a drug reference guide was included in the $20 nominal fee requested. As quickly as technology changes, updated drug information is essential and opens additional treatment opportunities.

What The Emerging Research Tells Us
Indeed, many of the most basic modalities take on renewed meaning when they are presented at major conferences and we, in turn, offer them to our patients.

In the new but old category, one may achieve dramatic improvement of knee pain due to osteoarthritis with as little as a 15 to 20 pound reduction in weight.3 The modalities described in an American College of Rheumatology (ACR) study are so familiar that they are almost too unsophisticated for contemplation. Cutting back 500 calories per day, for instance, will result in approximately 15 pounds of weight loss in six months. Parking at the furthest space both for work and social and shopping activities add gentle, episodic exercise to an otherwise sedentary lifestyle.

The ultimate goal would be to accumulate 10,000 steps per day in addition to dietary modification so a pedometer is recommended. The American Academy of Family Physicians’ (AAFP) program (www.aafp.org/x37835.xml) can aid patients and us in achieving these exercise and weight loss goals.

At the November ACR meeting, researchers determined that the old standby combination of glucosamine and chondroitin was no more effective than the placebo for reducing mild osteoarthritis pain in the knee as per the findings from the infamous Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), which was funded by the National Institutes of Health (NIH).

However, many rheumatologists did not accept these findings and subsequent publication of the study in a recent issue of The New England Journal Of Medicine suggested that the combination of glucosamine and chondroitin may be efficacious for those with moderate to severe pain from osteoarthritis in the knee.4

Unconventional Modalities: What Some Small Studies Have Found

Sometimes even the small studies reported can change the quality of life for our patients.
One very stimulating recent study reported that Viagra has been shown to be effective for refractory Raynaud’s disease.5 While we have learned to use channel blockers and angiotensin II receptor agonists to help treat this condition, these are not effective in all patients. According to this study, using 50 mg of Viagra twice a day can make the difference between pain and peripheral ulcerations with this rheumatologic disease.
Another exciting development is the use of Botox for trigeminal neuralgia and severe facial pain.6 Although this is not specifically for a rheumatoid disease, pain management advances are often on the forefront for other disease states and certainly well worth knowing about when it comes to primary care and rheumatology practice.

Although Botox is best known for masking aging, it is approved in the U.S. for strabismus, torticollis, hyperhidrosis (severe sweating) and blepharospasm. Other possible indications currently being studied for Botox include migraine headaches, post-surgical pain syndromes and temporomandibular joint syndrome, which can be a crippling musculoskeletal disorder in its own right.

Anecdotally, my patients have told me that they self-medicate with marijuana for various disorders including rheumatoid arthritis, multiple sclerosis and other chronic diseases including terminal cancer with good results. A recent study of Sativex has shown definite pain relief in arthritis patients although the researchers concede they did not see a regression of early morning stiffness.7 Reportedly, when this medication is inhaled, there is no associated euphoria or sensation of being “high.” Researchers of the study note significantly improved sleep for the 58 study patients.

Not yet sanctioned by the FDA in the United States, Sativex has been approved in Canada for use with neuropathic pain associated with multiple sclerosis.

Final Notes
We in health care can be forever vigilant and learn every day of our lives about emerging medications and facilitate increased knowledge among our patients. By being alert, we can indeed inspire, guide and be taught by the very patients for whom we care. Whether we employ the wacky, mundane or new uses of old modalities, we should remember our multiple roles in healthcare as educators, advocates and healers.