Ask the Doctors February 2005 Issue

Ask Dr. Marks: 02/05

My doctor has prescribed various DMARDs—Plaquenil, Arava, Rheumatrex—for my rheumatoid arthritis, but none of them seem to work. He has suggested beginning a  Prosorba-column treatment. What is it, and why does it work when other treat-ments don’t? Are there any side effects?

Prosorba-column treatment is an infrequently prescribed treatment for rheumatoid arthritis that is often used when standard treatments fail. The patient first undergoes plasmapheresis, which is the removal of blood and separation of plasma from the red blood cells. The plasma is then drawn through a Prosorba column. Within the column is staphylococcus antigen, a bacterial substance that absorbs factors that cause inflammation. The treatment is performed weekly for 12 weeks. When effective (about 50 percent of patients will respond to treatment), the results can last six to eight months. There are no side effects from this treatment.

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My husband has arthritis in his hip. We’ve been looking into what alternatives he has, if any, other than surgery. I’ve been told that doctors sometimes prescribe a  procedure called prolotherapy. Do you have any advice on this procedure?

Prolotherapy has been practiced for more than 60 years. The name is derived from the word “proliferation.” Advocates claim that the injection of a dextrose solution into a damaged ligament or tendon causes a localized inflammation that increases the blood supply and promotes healing. The treatment is claimed to increase the flow of nutrients, causing a proliferation of new ligament or tendon tissue. The practitioner usually recommends multiple injections over time. The scientific basis for prolotherapy is sparse, unconvincing, and dates back to the 1980s. This unproven treatment should not be considered as a replacement for the conventional and clinically proven medical and surgical treatment of arthritis.

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I’ve heard that excessive growth of blood vessels can contribute to joint damage   associated with rheumatoid arthritis. I also understand that studies are underway to develop drugs that control blood-vessel growth. What’s the latest on this?

Angiogenesis, the medical term for blood-vessel growth, is only one step in a complex disease process that results in joint damage. The real culprit in joint destruction is the synovial membrane, which produces chemical substances called cytokines that activate bone reabsorption, or bone loss. Angiogenesis allows the cytokine-producing synovial membrane to proliferate. The control of angiogenesis is an active area of research for both rheumatoid arthritis and some cancers. Currently, no medications on the market can control this process.