Jul 29, 2011 8:19 PM
For a few years, Andrew Ellis tried to tough out the pain, which started in his thumb. A boxer and football player in college, Ellis, 58, was used to aches and pains. He'd even broken his thumb once, so he told himself the new pain was from the old break. Then his other thumb began to hurt. Soon, he had pain in his toes and the balls of his feet. When his neck began to hurt, he finally admitted to himself that it was time to see a doctor.
"I said to myself, 'There's something wrong," recalls Ellis, who retired after 28 years in the military and now lives in Bel Air, Md.
He was right. Ellis learned that he had rheumatoid arthritis.
For a man, that's a rather uncommon diagnosis. Of the estimated 1.3 million people with the disease in the U.S., women outnumber men by as much as three to one.
It's not known why the condition is so much more common among women, though there's evidence to suggest that hormonal differences might explain at least some of the disparity in numbers. In fact, other rheumatic diseases, such as lupus and fibromyalgia, also affect many more women than men.
Rheumatoid arthritis is an autoimmune disease. It causes the body's immune system to attack the lining of joints. This leads to painful inflammation, swelling, and stiffness. In advanced stages, the damage caused by such inflammation can be quite debilitating.
RA symptoms can last anywhere from a few months to a lifetime. For some people, it flares up on occasion, then temporarily goes into remission; for others, it can be a constant, painful presence.
For men with the disease, there may be some good news. According to rheumatologist Grant Louie, MD, an arthritis specialist at The Johns Hopkins Hospital in Baltimore, men may have a less severe disease course than women. Men may also be more likely to have their disease go into remission, especially if it is caught and treated early.
Developing the disease early is important for other reasons, as well. According to the Arthritis Foundation, the earlier joint damage due to the disease often occurs in the first two years.
Many men, though, are much less likely than women to see a doctor, for arthritis or anything else. Ellis is a perfect example. He put up with his pain for three to four years before consulting with a physician.
"Men are often diagnosed later because they tend to downplay their symptoms," says Louie, who is treating Ellis' RA. "They may not recognize that it is something that they need treatment for."
Louie adds that men also may have fewer functional disabilities than women do. But the reason may be that men are underreporting the extent of the difficulties that the disease is causing. This also comes up when diagnosing RA.
One of the standard diagnostic tests involves probing joints for tenderness. As the doctor does this, the patient ranks the amount of discomfort he experiences.
"A man may be reluctant to say, 'This hurts,' because it would reveal weakness, which could make it more difficult to evaluate the disease," Louie says. "The good news is there are also objective measures."
Blood tests, for example, will reveal the presence of particular antibodies associated with RA, as well as measure indicators of inflammation, such as C-reactive protein levels. So the arthritis can be diagnosed even if the man won't admit to feeling the pain.
But the first order of business, says Louie, is getting men to admit that they are experiencing pain and then to see a doctor.
"We need to advise men so that they are aware that their symptoms may be rheumatoid arthritis," Louie says. "The chances for successful treatment are higher the earlier we can catch it."
Many different medications are used to control RA. They range from analgesics for pain relief to non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation to a class of medications known as disease-modifying antirheumatic drugs (DMARDs), which can slow down the progression of rheumatoid arthritis.
For his arthritis, Ellis takes an NSAID, as well as methotrexate, a DMARD that Louie calls the "mainstay" of arthritis treatment. Taking the drugs, which Ellis says has not caused any noticeable side effects, has eased his pain and stiffness considerably. The balls of his feet no longer trouble him, and he is now able to go running again each weekend.
The drugs, says Louie, can be extremely helpful, and men and women do equally well when taking them. But men, he says, are less likely than women to stick with their prescribed treatment. "Once they are being treated and start to feel better, they often say, 'I'll see if I can take less of the medication,'" Louie says.
Ellis was no exception. "I said to myself, 'I don't want to take all these drugs.' So he stopped taking the NSAID. "Then I had more pain, and I went back on it," he recalls.
"Everyone needs exercise, but especially patients with RA," says Louie. "RA patients who adhere to an active lifestyle appear to have less severe disease activity than those with more of a sedentary lifestyle."
That's true for men and women. But "participation in physical therapy and adherence to recommended exercise programs appear to be lower in men," Louie says.
Not Ellis. He is a lifelong exerciser. And that seems to have helped keep his arthritis under control. Although he wakes up achy and stiff, he says that doesn't last past his morning routine of pushups, sit ups, and leg lifts coupled with a cardio workout, either on his elliptical trainer or, on weekends, running.
"Whatever type of exercise, I'm out and doing something," he says, adding that the medications he takes help make that possible. "The methotrexate subdues the pain and lets me do those things."