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Arthritis and CF - how to treat

I am a near 40 year old female with CF. The last 15 years I have suffered form arthritis, and the last 6 years it seems to have exploded. All of my fingers are now affected, and I have had several surgeries to remove destructions and to permanently stabilize joints, thus leaving my fingers stiff. My doctors tell me I can not use the new socalled biological(?) arthritis medicines, and therefore I am left with virtually no medication which can stall the distructive process in my joints, all over my body. Do you have any advice or suggestions as to medicines I could try which will not be harmfull to my CF? I have p.a. and FEV1 less than 50 %
This is a very challenging problem. Firstly it is important to establish the nature of your arthritis. From the description it sounds like it may be rheumatoid arthritis but this is something you can check with your physician. There are a number of problems with joints associated with cystic fibrosis which present sometimes diagnostic and management challenges. Firstly it is important to establish the diagnosis clearly with your rheumatologist and CF physician. (Gyi KM Other systemic disorders in CF in Cystic Fibrosis, 3rd Edition, Hodson, Geddes and Bush, Hodder Arnold 2007)

Treatment of severe arthritis is very challenging because some of the drugs used cause immunosuppression. Some of the disease modifying drugs such as tumour necrosis factor a antagonists which are often called biologicals are problematic because they are associated with an increase in lung infections including tuberculosis in people who don't have CF. There are concerns that this agent may result in a flare of pseudomonas infection. They are not recommended in the treatment of CF associated severe arthritis. There are however, some other disease modifying drugs such as Gold, Methotrexate and Azathioprine which may be considered if your arthritis is severe. These should be discussed with your CF physician and rheumatology.
Best regards
Prof Elborn
The answer is edited by: Prof Judy Bradley