Juvenile Arthritis with Systemic Onset (Stills Disease) – Additional Opinion
Short summary
60-year-old patient was diagnosed with Still's disease. He was treated with high doses of corticosteroids (methylprednisolone, 110 mg daily). The dose was gradually lowered to 4 mg daily. In the last 2 years he had two exacerbations of the disease which were successfully treated by the increased dose of methylprednisolone. The expert recommends different complementary treatments that can be helpful to reduce pain , other symptoms and inflammation, reduce the dose of the drugs needed to control the disease, and improve quality of life. He also recommends combining more than one type of treatment to get the best results.
Patient's questions
1. Is there any possibility to treat his disease?
2. Are there any other medicines (except corticosteroids) available that have less side effects?
3. Are there any biological medicines? What are the risks of this treatment? What is the cost of this treatment?
Medical Background
Male, born in 1960
Diagnose: M08.2 Juvenile arthritis with systemic onset (Stills disease)
He had begun to feel ill at the age of 44, in 2004, with a fever (40 degrees Celsius), rashes and pain all over the body.
Treatment: Initially, he was treated with high doses of corticosteroids (methylprednisolone, 110 mg daily). The dose was gradually lowered to 4 mg daily. In the last 2 years he had two exacerbations of the disease which were successfully treated by the increased dose of methylprednisolone (10 days, 32 mg), which was later gradually lowered to 4 mg again.
Current physical status: Swelling of knee joints and small joints in hands. Occasionally he has a feeling of burning feet and at other times, a feeling of cold feet.
Medical opinion
Based on our clinical multi centres experience there is a benefit using one or more of the following treatments. The treatments can reduce symptoms considerably, improve quality of life and reduce the dose of the used drugs.
1) Acupuncture
Acupuncture is part of Traditional Chinese Medicine. By using fine sterile needles in specific points it can relief pain and inflammation of the joints.
The treatment should be frequent in the first 3-4 weeks once the pain starts to fade the treatment frequency can be reduced to once a week for a long time.
Safety: Acupuncture is safe to use with no side effects and can be combined with medications.
2) Herbs
-Tripterygium wilfordii - Thunder god vine is a perennial vine native to China, Japan, and Korea. Preparations made from the skinned root of TGV have been used in traditional Chinese medicine to treat inflammatory and autoimmune diseases.
Safety: side effects can occur and may include stomach upset, diarrhea, and skin rash.
More herbs include:
-Ginger
-Curcumin (a component of the spice turmeric)
-Boswellia (also called Indian frankincense, made from the resin of a tree that grows in India)
These three botanicals have a long history of use in Ayurveda (Indian Traditional Medicine) to treat inflammatory conditions.
Safety: Ginger is not recommended for people who have a bleeding disorder, a heart condition, or diabetes.
Curcumin can cause gallbladder contractions and should not be used by people with gallbladder disease or gallstones.
Boswellia can have side effects of stomach pain, stomach upset, nausea, and diarrhea in some cases.
3) Supplements:
Gamma-Linolenic Acid (GLA)
GLA is an omega-6 fatty acid that is found in the oils of some plant seeds, including evening primrose (Oenothera biennis L.), borage (Borago officinalis L.), and black currant (Ribes nigrum L.). GLA can be used by the body to make substances that reduce inflammation.
Safety: Borage oil and evening primrose oil might increase the risk of bleeding and bruising, especially in people taking blood-thinning drugs, such as aspirin, clopidogrel, NSAIDs, or warfarin. –
Fish Oil
Fish oil contains high amounts of two omega-3 fatty acids: EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). As with GLA, the body can use omega-3s to make substances that reduce inflammation.
Safety: in high doses might increase the risk of bleeding and bruising, in people taking blood-thinning drugs.
4) Homotoxicology
Homotoxicology uses a large combination of homeopathic remedies with anti inflammatory and pain controlling activity, it can be administered orally or combined with local injections .combinations like ZEEL and TRAUMEEL can be helpful.
Safety: very safe, no side effects or drug interactions are known
In summary, systemic rheumatoid arthritis is an incurable autoimmune disorder, but the use of Complementary Medicine can be helpful to reduce pain, inflammation and drugs needed to control the disease. It is recommended to combine more than one type of treatment to get the best results.
