Scardiosis: Doctors share clinical findings with peers
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| Rheumatologist Dr. Jacob Aelion looks at Ellen Dinwiddie's knee. |
Dinwiddie has sarcoidosis, a disease in which granulomas (microscopic islands of inflammatory cells) are formed throughout the body, including the lymph nodes, lungs, skin, liver and eyes.
Dr. Jacob Aelion and Dr. Satish Odhav, physicians at the Arthritis Clinic, discovered that the anti-TNF drug Adalimumab worked in patients like Dinwiddie, who did not respond to conventional treatment.
When they submitted their findings to the American College of Rheumatology, they were asked to present a paper at the group’s annual meeting in October 2004 in San Antonio, Texas. About 6,000 physicians attended the meeting. “Our findings were well received,” says Dr. Aelion.
This was the second time in a year that Dr. Aelion and Dr. Odhav were asked to share the results of their clinical findings at an international gathering of their peers. In June 2004, at the annual meeting of the European League Against Rheumatism in Berlin, they described how Anakinra, a new arthritis drug, had amazing results in patients with Adult Onset Still’s Disease (a variant of rheumatoid arthritis) who did not respond to conventional treatment.
The cause of sarcoidosis is unknown. Symptoms vary because the disease can affect different parts of the body in different people. In a significant number of patients, the disease is mild and can be self limited. When it involves the lungs, it can lead to shortness of breath and even respiratory failure. “Its progression varies in different individuals,” says Dr. Aelion. “In general it tends to be more aggressive in African Americans.”
Rheumatologists like Dr. Aelion and Dr. Odhav often see patients with sarcoidosis when it affects the joints and muscles. Bone and cutaneous involvement tend to be particularly resistant to treatment. It has been estimated that the overall mortality rate in this subgroup of patients is as high as 12 percent.
They tried Adalimumab to treat three of their patients with sarcoidosis who were not responding to the conventional treatment with steroids (cortisone), and cytotoxics (cancer drugs). “We were using Adalimumab to treat rheumatoid arthritis,” says Dr. Odhav. “Its success to treat recalcitrant sarcoidosis is a great advancement.”
Adalimumab blocks the action of TNF, a type of molecule that promotes granuloma formation. “We discovered that if one gives these patients the anti-TNF agent, the granulomas tend to melt away and healing sets in,” says Dr. Aelion.
Dinwiddie was one of those patients. She first went to a plastic surgeon when she felt hard growths in her shins and elbows. “My right knee felt like a stale cookie,” she says. “I could almost feel it growing. I was scared to death.” The left side of her face also looked like she had had a stroke and she couldn’t close her eye. The pain, particularly in her legs, was difficult, she says.
Her physicians diagnosed her with sarcoidosis, but then, she didn’t respond to the usual treatment with systemic steroids and cytotoxics. She even underwent unsuccessful radiation therapy.
Six weeks after starting Adalimumab, she could feel a difference. Within four months, most of the painful skin lesions had resolved.
“It’s a miracle drug,” says the Camden resident who is back to her favorite activities again. “Without it, I’m sure I would be in a wheelchair today. I can’t say too much about how well I’ve been treated by the staff and physicians at the Arthritis Clinic.”