Without hard evidence,insurance companies reluctant to cover therapies
Sharon VonMatt went to the emergency room almost three years ago thinking she was having a heart attack. There was pressure in her chest and inflammation around her rib cage. But, it wasn’t a heart attack.
From there, the Waterville resident went downhill so fast that a week and a half later, VonMatt, 46, couldn’t get off the couch without help.
She thought she was dying of Lou Gehrig’s disease. It turned out to be rheumatoid arthritis.
When it comes to all forms of arthritis, pain relief is a big deal. Yet arthritis sufferers have faced quite a bit of bad news in the last two years.
One popular drug, Vioxx, was pulled off the market in 2004 over concerns about an increased risk of heart attacks and strokes.
Since last spring, its sister drugs, other non steroidal anti-inflammatory drugs (known as NSAIDs), must carry mandatory warnings that they increase the risk of cardiovascular events and potentially life-threatening gastrointestinal bleeding.
And a study published in February found that glucosamine and chondroitin, popular supplements taken for arthritis pain, are no better than placebos for most osteoarthritic knee pain.
But don’t let the bad news fool you. This really is a good time for arthritis relief, said VonMatt’s rheumatologist, Dr. Allan Smiley of Slocum-Dickson Medical Group in New Hartford. Two new drugs for rheumatoid arthritis – Rituximab and Orencia – already have been approved this year, he said.
And they’re so effective, doctors have been talking about them putting rheumatoid arthritis into remission, he said.
“This is wonderful news. We now have five drugs that are available for the treatment of rheumatoid arthritis,” Smiley said.
There are also about five products and treatments available for osteoarthritis, Smiley said, including viscosupplementation, which involves injecting a product into the knee with hope of delaying the need for knee-replacement surgery.
Patients are excited about all the possibilities, Smiley said.
“It’s so different than it was even seven years ago, especially for the rheumatoid arthritis patients who had nothing up until 1998,” he said.
As for all the bad-news products, a small number of patients do say that only Vioxx worked well for them, Smiley said.
And some patients have gone off the other NSAIDs because of the warnings, he said.
“There are always going to be people that are willing to go off medicines. There’s a huge rise in the use of alternative and complementary medicines,” Smiley said.
Some patients insist that these alternatives help them, Smiley said. Confronted with the results of the glucosamine and chondroitin study, about half of patients on the supplements said they would stick with them anyway, he said.
And they still may find relief.
“The placebo effect basically works 40 percent of the time. Giving someone a dummy sugar pill, it will work,” Smiley said.
As for VonMatt, she’s been lucky. After her diagnosis, she went on a combination of methotrexate and prednisone, which worked well. But after about a year, her symptoms returned. So she stayed on methotrexate and started getting a Remicade infusion every six weeks. “It’s been wonderful. I actually feel like I have my life back,” she said.
And the good news could keep coming for arthritis patients.
“I think the good news is that the drug companies are going after the baby-boomer market with a vengeance and, if you look at it very cynically, that is where they can make money, …” Smiley said.
“It is no coincidence in my mind that all these things are going on right now.”