Doctor’s Diary: the radical approach to rheumatoid arthritis treatment has been more than justified

M ost powerful modifying antirheumatic disease drugs (or FAME) in current use half a century or more was discovered, and although certainly alleviate the characteristic pain and swelling joints, they did not stop the process of deactivation of aggressive bone destruction that make become progressively more deformed. They were good, but frustrating, is not enough.

His tendency to cause side effects was the main limiting factor for use, promoting a policy of prudent prescription, especially in the early stages of the disease when it can be relatively mild and confined to only a couple of joints in the hands . The dose methotrexate then increase progressively and other drugs added to the point that they effectively abolished all signs of inflammation. In addition, it was argued, the sooner this is started, the better.

Initially, many specialists were reluctant to adopt this radical approach in the early stages of the disease, for obvious reasons. As one of them he said: “The patient leaves the room and says ‘This doctor is completely crazy I come with wrist pain, only to be told I have to take this toxic cocktail of drugs..'”

However, it has been more than justified by the benefits in the prevention of bone destruction that relentless and, as noted, that the dramatic improvement in survival. It is an impressive achievement, with lessons to rethink the management of other severe inflammatory disorders.

Cancer Management

My recent comments in this column that “routine surveillance” – regular scans and blood tests after surgery for localized tumors of the breast and colon – no, it now appears, to further improve the result has been criticized for being “discouraging and useless.”

“I prefer the idea that cancer will get me in the end,” writes a woman who has recently undergone surgery for early breast cancer, “and my optimism has diminished somewhat.”

My apologies – but this is certainly a bad understandable interpretation. Those who are cured by surgery – the vast majority – obviously we stay healed, and although many certainly welcome the tranquility of the regular hospital checks confirming everything is clear, that is, by definition, does not substantially alter the situation


This need to ensure that, although specious, surgical management of routine cancer really makes the difference is further illustrated by a study published this month in the British Journal of Surgery on the merits of the radical procedure to remove all lymph nodes neck in patients with thyroid cancer.

Surgery to remove the gland itself is very effective, with a cure rate above 90 percent. What additional excision of nodes in the neck in anticipation that the cancer may have spread locally improve on this? Apparently not – therefore, in the future, it is advised that people with the disease can save this traumatic surgical procedure


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