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Swinging for the Green: Driving Away Rheumatoid Arthritis

Elizabeth Donovan recently accomplished something she never thought possible. The Cutchogue, Long Island resident won a golf tournament. "I was in shock," she says. There was a time she doubted she'd ever be able to swing a golf club, let alone take home a trophy declaring her the champion in her nine-hole flight.

Mrs. Donovan has come a long way since being diagnosed with rheumatoid arthritis (RA) more than four decades ago at age 28. In its most severe form, RA ruthlessly attacks the body's joints, causing pain, swelling, loss of function and eventual deformity. Mrs. Donovan has had more than 20 operations to repair the ravages of the crippling disease. She underwent ankle replacement surgery in 1977, hip replacement in 1982 and 10 hand surgeries to repair the joints in her fingers. She needed all of her toes reconstructed because the deformity prevented her from wearing shoes. At one time, she wore a leg brace that went from her shoe up to her knee. She has a steel bar in her wrist.

"I can remember when the disease was rampant? when it started. I had to crawl up the stairs. Some days I'd be in bed and couldn't move, especially if the weather was bad. It's extremely painful when there's a flare-up," she explains.

RA is a form of arthritis that causes inflammation, attacking the lining of the joints. It can affect any joint in the body, but is most common in the wrist and fingers. RA can affect other parts of the body, as well, such as the eyes and lungs. It's an autoimmune disease, which means the immune system turns on itself, attacking the body's own tissues. Rheumatoid arthritis is different from osteoarthritis, which is more of a mechanical wear and tear problem for joints that usually gets worse as we age.

RA often starts between ages 25 and 55, and affects more women than men. Occasionally people have the disease for only a short time, or their symptoms come and go.

Most often, RA is a progressive disease, and in Mrs. Donovan's case, it was relentless. "Almost every joint in my body was affected. I had it from my cheekbones to my toes." But she says she considers herself lucky. "I had strong support from family and friends, and lots of prayers." She also had an excellent rheumatologist on Long Island to help her get through it, especially in the beginning.

When her doctor retired, she was at a loss. She had gone to Hospital for Special Surgery for foot surgery, so when she needed a rheumatologist, she again turned to HSS. She has been seeing Theodore R. Fields, MD, FACP, Clinical Director of the Gosden Robinson Inflammatory Arthritis Center, for the past eight years.

The 94-mile trip from Cutchogue to Manhattan takes two hours, but Mrs. Donovan says she wouldn't go anywhere else. Her husband recently had hand surgery at HSS, as well. "We feel it's worth it because the care is so good," she says. "I feel fortunate Dr. Fields is my doctor."

Today, thanks to major advances in treatment and good medical care, Mrs. Donovan's RA is under control. At age 73 she can do many things she couldn't do at age 30. "I never thought I'd be playing golf. Now I can do almost anything," she says.

In the past, exacerbations controlled her life. But as RA waged a war in her body, Mrs. Donovan fought her own quiet battle, unwilling to let the disease get the better of her. She had six children, each one about a year apart, and raised them on her own. She took a trip with her husband to Europe, even though she was in a wheelchair. Although bouts with the disease could be debilitating, she always did as much as she could.

Dr. Fields is encouraged by her progress and enthusiastic about new medications that are helping more people, even those with severe RA. "Mrs. Donovan is a testimonial of someone who started on the old medicines and is now doing very well on the newer medications," he says. "More than 95 percent of patients can get good control of RA, but it sometimes takes some trial and error to find the medications that will work for them."

The biggest misconception is that if someone can tolerate RA symptoms, it's fine to forgo treatment, according to Dr. Fields. "Over time it can damage joints and tendons and lead to deformity," he says. "If you catch RA early, you can delay or prevent damage and avoid surgery. Medications are most effective when the disease is in its early stages. The medicine stops the inflammation, and pain decreases dramatically."

Dr. Fields says one of the goals of the Early Arthritis Center is to educate doctors and patients about the importance of early diagnosis and treatment. When people call for an appointment at the center, one of the doctors will see them within a week. The Center offers comprehensive care, with a medical team that includes physical therapists, nurse educators and even surgeons, if needed.

Dr. Fields is encouraged by Mrs. Donovan's progress and impressed by her golf trophy, especially since she had surgery on all of her fingers. Mrs. Donovan is grateful she can now live life to the fullest. "It makes you very happy, you can do things with your girlfriends, things you watched other people doing for so many years."

She and her husband will be celebrating their 50th anniversary this year. They will be taking a river trip from Budapest to Prague. Part of the visit will be on land, and this time she'll be walking.

Driving away Rheumatoid Arthritis