Nostalgic for the Olden Days? Think Again
Once upon a time, when there were no smartphones or Teslas, and writers used pencils and paper (and maybe typewriters), having rheumatoid arthritis was a really serious problem.
Everyone thought only old people got this disease. It was like this: “there’s gramps, limping along slowly, leaning heavily on his cane. He has the rheumatiz.” Or “there’s gramma, crocheting winter scarves--slowly, slowly--with gnarled, misshapen fingers, but she rarely complains. She has arthritis.”
If you were 18 or 25 or 31 and you said you had rheumatoid arthritis they’d take you for a hypochondriac--if they didn’t dismiss you outright. They’d think you were, at least, deluded and whiny. And if you finally convinced them that you really did have RA, then they’d tell you that their aunt had that, too. She just took some aspirin for it; made her all better.
There were other misconceptions back in the olden days, too. Like how people thought osteoarthritis and rheumatoid arthritis were the same disease. Rheumatism equals arthritis, and vice versa. They thought it wasn’t very serious, because, well, it was only arthritis, right?
There wasn’t much you could do for RA in the olden days. The few medical treatments available were hopeful but mostly useless. But if you were willing to try folk remedies, there were as many to try as there were people to think them up.
For instance, you could rub hot vinegar on the offending joints. Or, you could gulp down a refreshing glass of orange juice --with cod liver oil whipped into it--right before bedtime. Yum! One can only hope it helped.
There were some common-sense remedies, too. Some people swore that hot baths soothed their flared joints. Others swore they felt better when they stopped eating macaroni, white bread, and cake, or drank a cup of hot alfalfa tea each morning and night. A liniment made from camphor, methyl salicylate (salicylin is the active ingredient in aspirin, found in willow bark), eucalyptus oil, and menthol was touted as beneficial, as was a teaspoon of sassafras steeped in a fifth of whiskey for 24 hours and taken before meals. Some took therapeutic doses of vitamins; and others said that learning self-control to avoid emotional upsets reduced their flares considerably.
That liniment sounds like it might be soothing; it probably still exists in some form that you can buy online today. And we know that emotional stress can trigger flares (though not always, and not for everyone).
Then there was good ol’ snake oil, which is still with us today. See: Internet.
None of these things offered any sort of lasting relief, though. And they didn’t touch the disease itself at all. But back then, medicine didn’t have any answers. Willow bark, naturally infused with salicylin, relieves pain, an effect noted by Hippocrates himself. But as anyone with RA knows, aspirin (which contains components of salicylin from willow bark even today) doesn’t come close to relieving the pain of a bad flare.
Since ancient times, the real, serious analgesia (pain relief) has always come from the opium poppy. The poppy’s derivatives, such as morphine and codeine, miraculously relieve pain, but the relief can be pricey. All opiates require increasing doses to remain effective, which can cause dependence over long periods, and in some people, addiction. And of course, once the dose reaches a certain point, it becomes deadly.
Rheumatoid arthritis is just as incurable now as it was in the Golden Oldies. But the 19th and 20th Centuries produced some amazing drugs, and some of them actually worked.
Quinine, used since the 17th Century to treat malaria, proved useful in treating lupus in 1895; by the late 1950s, drugs derived from it, like hydroxychloroquine (Plaquenil), were slowing RA’s progression by decreasing inflammation levels in the body. Drugs of this type are disease modifying anti-rheumatic drugs (DMARDs). Sulfasalazine came along in the 1940s, and other DMARDs soon followed, including (among others) leflunomide and gold tablets or injections.
The chemotherapy drug methotrexate was developed to treat a form of juvenile leukemia in 1950. Thirty years later, medical science had discovered that in very low doses, it worked in many patients to slow RA’s progression. Methotrexate is a “gold standard” drug today, the king of the DMARDs.
Cortisone, a steroid, saw its first use in 1949. It worked so well to relieve pain and function in RA patients that the medical world considered it a wonder drug—that it, until they discovered its potentially terrible and sometimes deadly side effects. Cortisone is still wondrous. It’s still commonly prescribed today, though in much smaller doses and with far, far greater care. (Patients tend to have a love/hate relationship with cortisone and its cousins, calling it “the devil’s tic-tacs.”)
There were NSAIDs (non-steroidal anti-inflammatory drugs), too. These were non-opioid analgesics that worked by decreasing inflammation in the body without treating the underlying disease. Aspirin, as noted above, was the oldest and most widely used NSAID. Bayer marketed the first over-the-counter version in the form of tablets in 1897. By the 1950s, ibuprofen, naproxen, and a variety of others joined the list. Acetaminophen (paracetamol), best known as the non-opioid pain reliever Tylenol, never made the list of NSAIDs because it doesn’t relieve inflammation.
With the new century came the first biologic DMARDs. Made with living cells, these drugs work by targeting individual protein antibodies produced by the immune system (such as tumor necrosis factor (TNF)) that contribute to RA. Used alone or in tandem with methotrexate (and in some cases, other synthetic DMARDs), they’ve proven to be remarkably effective in many patients, inhibiting the progression of the disease and, in the process, relieving symptoms. The biologics include the TNF-blockers (also called inhibitors) adalimumab (Humira), certolizumab pegol (Cimzia), etanercept (Enbrel), and infliximab (Remicade). Others include the T-cell costimulator, abatacept (Orencia), the B-cell inhibitor rituximab (Rituxan), and the Interleukin-1 inhibitor anakinra (Kineret).
I’ve lived in the olden days, when my doctor was limited to treating my rheumatoid disease (a much better name for it, since arthritis is just one of its symptoms) with NSAIDs and a couple of the early DMARDs. None of them had any effect on my disease; the only relief I had was from opioid analgesics.
Since the turn of the century, though, my doctors have had far more treatment options. And while I’m still waiting for the biologics to perform their miracles on me, I hold out hope that they will. They’ve been life-savers for so many others.
In many ways, we’ve come a long, long way since the days of hot vinegar and orange juice-cod liver oil cocktails. But in many others we’re still running in place.
An aspirin and a hot soak in the tub just aren’t enough.
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