A BRIEF HISTORY OF RA AND ITS TREATMENT

I thought it would be interesting to delve into the history of RA. It goes back pretty far; farther than I thought it would. Some skeletal remains in what is now Tennessee (USA) date back to 4500 BC and have shown some signs of Rheumatoid Arthritis. So far, that’s been the earliest appearance of this condition.

The first documented appearance of Rheumatoid Arthritis comes much later in 123 AD in India. A text called the Caraka Samhita contains a description of what sounds like RA, painful joints in both hands and feet, eventually spreading to other areas of the body, there was also record of occasional fever and appetite loss.

In 1591, a French physician, Guillaume de Baillou, provided the first modern descriptions of rheumatism and arthritis, which he defined in his treatise Liber de Rheumatismo et Pleuritide dorsali.He uses the term “rheumatism” to give description to an ailment with inflammation, stiffness in muscles, and pain in the joints. “The whole body hurts, in some the face is flushed; pain is most severe around the joints, so that the slightest movement of the foot, hand or fingers causes a cry of pain…At night…the pain becomes more serious and the patient cannot sleep.”

A Peruvian bark containing quinine, an anti- malarial agent was being used in 1680 to treat the symptoms of rheumatism. Then in 1763, another bark was discovered to produce positive results in fighting the effects of rheumatism; willow bark contains salicylate, the main ingredient for aspirin.

The term rheumatoid arthritis wasn’t coined until a London physician, Sir Alfred Garrod, came up with it in 1859 and that was the start of RA being recorded in medical books and records. Sir Alfred also contributed greatly to our knowledge of the causation of gout. Before the 19th century came to an end, joint replacement surgery had begun with a carbon steel screw and plates system developed by W.A. Lane, in 1893. The x-ray was developed in 1895 allowing physicians to see actual damage and inflammation of an arthritis sufferer.

Two years later, in 1897, aspirin was manufactured by the company Bayer, using the willow bark substance, discovered over a century before. It fast became known world-wide as a standard treatment for pain and rheumatoid arthritis.

Turning the corner into the new twentieth century, gold shots became a form of therapy for this chronic condition. In 1927, gold salts began to be injected into patients periodically to relieve muscle pain, associated with Rheumatoid Arthritis.

Two years later, in 1929, the first artificial hip joint was patented and in 1939, down in Melbourne Australia, Sir McFarlane Burnet introduced the first autoimmunity theory. This is the theory that antibodies cause the body’s immune system to malfunction and attack its own tissues. Almost 70 years later, this theory still holds true!

In the 1940’s Rheumatoid Arthritis gained more recognition with the 1941 American Rheumatism Association, and in 1946, the American Committee to Control Rheumatism was founded and two short years later the Arthritis Foundation (USA) was founded.

More important discoveries were uncovered in 1948; Drs. E.C. Kendall and Philip Hench showed the world that steroid hormones could be used as a therapeutic anti-inflammatory. For this they won the Nobel Prize! Still keeping with 1948, a discovery just as important was made known; a test was developed called the Rose-Waaler diagnostic test, which reveals the antibody known as the rheumatoid factor, found only in the blood of people with Rheumatoid Arthritis.

The next fifty years of the century saw many new treatments, procedures and surgeries discovered. The year 1955 saw Prednisone, a synthetic off shoot of cortisone ushered in and so began the dawn of oral corticosteroid medication. Plaquenil was also introduced as the new anti-malarial drug used to put Rheumatoid Arthritis into remission (remember the Peruvian bark extract used in 1680? That’s the basis!).

The late twentieth century and the early twenty first century have seen the advent of a variety of NSAIDS (Non-steroidal anti-inflammatory drugs) and DMARDS (Disease – modifying anti rheumatic drugs). A relatively new group of drugs are the anti-TNF drugs – adlimumab, etanercept and infliximab and the B-cell drug rituximab which are known as biologics. Biologics are currently only being used in people who have not responded to other disease modifying drugs. Hopefully, the next few years will see further strides in the treatment of RA and other forms of arthritis!

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