A Journey Through Pain and Possibility

by Omar Marzouk

Photo source: https://www.lin.health/insights/is-chronic-pain-a-disability-empowering-those-in-pain-to-get-the-resources-they-need

Imagine waking up to a world where every morning is a battle against your own body, a symphony of sensations that weave pain into the fabric of your existence. Even the sheer caress of your bed sheet against your skin becomes an aching reminder of the enduring discomfort. As you summon the courage to sit up, every motion is met with immense resistance, each joint whining and creaking like a shabby antique door, opening up to yet another day of challenge. The plaintive shrieks of your bones, echoing like the mournful whispers of ancient, rusty hinges unveil the persisting imprints of time and the steep toll that individuals with rheumatic diseases are forced to pay. 

The act of getting out of bed is not merely a physical endeavour, but rather, a journey through immense valleys of discomfort. Every step, once taken for granted, echoes with the persistent rhythm of pain coursing through your joints. You tread slowly and carefully as if you are navigating a terrain encumbered with hidden traps. Even the slightest of missteps can send mountainous shockwaves that reverberate throughout your body. 

This is the harsh reality for millions of people living with rheumatic disease, a diverse family of autoimmune disorders. Rheumatic Disease is not solely limited to a dull ache in one’s knees or stiff fingers. Rather, a profound and complete transformation of what those who are not plagued with Rheumatoid Arthritis (RA) consider ordinary.

Even the tender hug of a loved one or the pleasure of brewing a steaming cup of coffee, with its rich and inviting aroma promising warm, comforting delight is dimmed by the striking intrusion of pain. Those simple acts we often take for granted are the very experiences that those living with RA yearn to enjoy without the burden of pain.

Within the intricate tapestry that is rheumatoid arthritis (RA), its pathogenesis is a captivating and complex tale. A story that gathers multiple villains, including genetics, environment, immunological factors, and more, takes center stage to contribute to the development and expression of the disease. 

The precise molecular origins of RA remain unknown, however, it is generally understood that both environment and genetics influence RA expression. Both factors trigger autoimmune responses well before the onset of clinical symptoms.  

Despite the elusivity of the disease, interdisciplinary collaborations among physicians,  rheumatologists and immunologists provide a ray of hope for RA patients. These technologies offer a promising outlook for those affected in the form of advancements in diagnosis and treatment. 

However, prior to our exploration of these advancements that promise an improvement in the quality of life for those suffering from RA, we must take a brief detour, educating ourselves about the known symptoms and pathology. 

This story starts with environmental triggers affecting mucosal surfaces, leading to the creation of antibodies that play a role in the onset of rheumatoid arthritis. While the exact mechanisms are not fully understood, inflammation and various molecules contribute to severe arthritis, damaging cartilage and bone in the process.

Our narrative closes on a somber note of irreversible loss, the articular cartilage and bone suffer devastating defeat, soon after the emergence of RA. 

Yet, a glimmer of hope remains amid this struggle. Physicians worldwide are determined to explore technologies offering hope and an improved quality of life for individuals with RA, empowering them to overcome challenges and embrace each day.

Starting in the 1950s, there have been 3 classes of drugs utilized in the treatment of RA patients: non-steroidal anti-inflammatory agents (NSAIDs), corticosteroids, and disease modifying anti-rheumatic drugs (DMARDs). The most commonly used and available, being NSAIDs. (John Hopkins, 2020). 

NSAIDs inhibit the generation of prostaglandins by blocking cyclooxygenase enzymes, COX-1 and COX-2. Prostaglandins are versatile molecules in our body’s orchestra, playing a dual role in our body’s complex symphony. On one hand, they act as instigators of inflammation and pain, while on the other, they serve as crucial regulators of normal bodily functions, akin to peacekeepers maintaining balance. (John Hopkins, 2020). 

Inhibition of COX-1, a constitutively expressed enzyme in most human tissue plays a role in the maintenance of physiological functions, a reduction in prostaglandin protection, increasing the risk of adverse gastrointestinal side effects, primarily stomach ulcers. COX-1 inhibitors have been known to cause platelet inhibition through an inhibition of thromboxane A2 production. (Quershi, 2023).

Certain nonsteroidal anti-inflammatory drugs (NSAIDs), commonly known as COX-2 selective inhibitors or coxibs, have the ability to specifically target COX-2 while showing a greater level of sparing for COX-1. By selectively inhibiting these enzymes, they effectively diminish the production of prostaglandins that are responsible for inflammation and pain. Consequently, this targeted inhibition leads to notable anti-inflammatory effects. Compared to COX-1 inhibitors, these compounds show a reduced risk of gastrointestinal side effects. (Quershi, 2023). 

Ultimately, treatment is highly subjective and due to the complexity of RA, there is no means of quantitatively or definitively determining a universally effective treatment. 

My uncle bore the weight of RA and although NSAIDs provided some respite, they introduced a slew of other issues. Living in Egypt, he decided to explore other medical solutions alternative to those native to the Western paradigm of medicine. 

Amid the vibrant tapestry of Egyptian medicine, he encountered several smaller enclaves each sprouting from the roots of larger hospital-based divisions. These pioneers utilized 3-dimensional printing to conjure devices that whispered tales of enhanced stability and motor functions to his aching joints. One of these creations was an exoskeleton, like an artisan’s masterpiece, embracing the body, bestowing freedom of movement and painting hope upon the canvas of pain. The exoskeleton gracefully intertwines with the wearer’s body, providing enhanced stability and  improved joint mobility. It becomes a guardian of relief, bestowing upon those with RA the elegant dance of support, alleviating the heavy toll on their aching joints.

Despite the functionality of this marvel, its design remained a symphony of discomfort worn in the open, evoking whispers of embarrassment. Such a device was more suited to private use, finding its sanctuary in the realm of privacy. Regardless, this intricate contraption echoed the holistic ethos of Eastern medicine. It sang to the myriad of treatments, each a unique note in the symphony of possibilities, harmonizing to offer solace to those who sought relief from the relentless grip of RA. 

In the world of rheumatoid arthritis, where pain is a relentless adversary, we ventured on a journey through different paradigms of medicine. From the Western realms of NSAIDs and corticosteroids to the enchanting melodies of 3D-printed exoskeletons and Eastern holistic views, the quest for relief from this formidable foe took us far and wide.

We saw the diversity of treatments, each a unique brushstroke on the canvas of healing, putting on full display the individual paths taken by those afflicted. This journey has shown us that the key to resilience lies in collaboration, as it is only through interdisciplinary connections may we come together to offer hope and advancements in treatment. 

As the curtain falls on this chapter, we are reminded that the world of rheumatic diseases is a tapestry of pain and possibility and as this never-ending journey continues, escorted by innovation and the persistent spirit of those who seek an improved quality of life. In this pursuit, the light at the end of the tunnel brightly shines her graceful rays onto us, warming the hearts of those affected by rheumatoid disease.

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