Medications' Effects on Teeth

Q:  I am 37 and my teeth are dull and off-white. I've taken drugs for juvenile rheumatoid arthritis (JRA) for almost as long as I have had my permanent teeth, and I'm wondering if medications are responsible for the discoloration. Do arthritis drugs affect teeth? Would whitening toothpastes or treatments work for me?

A:  Your question is a common one. Certain drugs can cause the teeth to be dull and gray. However, without knowing the specific drugs you have taken, I can't say if that is the case for you.

I estimate from your question that you probably started medication for JRA in the 1970s. The most common drugs used for JRA at that time were aspirin, gold and hydroxychloroquine. D-penicillamine came out in the late 1970s and methotrexate emerged as an arthritis treatment in the 1980s. None of those drugs have actually been known to cause tooth discoloration. However, they have been associated with other mouth problems, such as discoloration and ulceration of the gums.

It is possible that drugs you took for other reasons, such as tetracycline for acne or iron preparations for anemia, may have affected your teeth.

The bleaching treatments now used for tooth discoloration may be beneficial in your case. Consult your dentist.

MURRAY PASSO, MD
Pediatric Rheumatologist

TWO KINDS OF LUPUS: WHAT'S THE DIFFERENCE
Q. I was recently diagnosed with lupus. Now I learn that there is a disease called discoid lupus and another called systemic lupus. What's the difference between these two diseases?

A. Both diseases are generally chronic, meaning they usually last a lifetime. Discoid lupus is primarily a skin disorder, characterized by a scarring skin rash. In most cases it does not affect the internal organs. Systemic lupus erythematosus (SLE), on the other hand, can affect the entire body, including the skin, joints, cardiovascular and nervous systems, as well as internal organs. In about 20 percent of cases, people with SLE will also have the skin lesions typical of discoid lupus.

For more information about lupus, request a copy of the Arthritis Foundation's lupus brochure from your local chapter or call the Alliance for Lupus Research, 800/867-1743.

LEONARD H. CALABRESE, DO
Rheumatologist

HOW LONG TILL BONES GET STRONGER?
Q. Just over a year ago I was diagnosed with osteoporosis and began taking 10 milligrams of Fosamax every morning. How long will it take this drug to build up my bones? At some point, can I stop taking it?

A. Alendrondate (Fosamax) starts working right away, but it will take a year to see any measurable results on tests of bone density. Depending on your age and how severe your osteoporosis is, you will probably have to take the drug for many years — maybe the rest of your life.

RONENN ROUBENOFF, MD, MHS
Rheumatologist

SURGERY FOR ARTHRITIS OF THE TOES
Q. I have osteoarthritis (OA) in both big toes, making it extremely painful to walk. My doctor has recommended that I have both of those joints replaced. If I do, will the pain stop? Are there any alternatives to the replacement of the toe joints?

A. The development of OA in the metatarsophalangeal joint (the joint closest to the sole of the foot) of the big toe is fairly common. People often complain of pain and swelling in the joint itself, increasing stiffness associated with the arthritis and the development of large spurs (bony growths) that can rub against the edges of shoes. Replacing the affected joints with artificial joints made of metal and polyethylene may or may not help ease the pain. Some surgeons report excellent results with such surgery; others have found that these joints are likely to loosen and cause pain.

Replacement of the joint is not the only surgical treatment option for big toes affected by arthritis. Other options include: removal of the spurs only (called cheilectomy); removal of the spurs along with a portion of the toe bone (called Keller bunionectomy); or fusion (arthrodesis) of the two bones that meet to form the joint into a single, rigid unit. Many foot surgeon specialists prefer these alternatives to joint replacement.

Before undergoing replacement of the toe joints, I would recommend that you ask your orthopaedic surgeon about his or her experience with the particular surgical procedure recommended. Also ask about the alternatives I have mentioned and how the results of these might compare with joint replacement in your surgeon's experience.

JEFFREY T. NUGENT, MD
Orthopaedic Surgeon

ECZEMA AND ARTHRITIS
Q. I have had eczema for two years and have recently begun experiencing symptoms of arthritis. Is it possible the two conditions are related? Is eczema an autoimmune disease?

A. Eczema — a skin condition characterized by inflamed, itchy skin covered with small fluid-filled blisters that ooze and crust over — is an autoimmune disease, a condition in which the immune system mistakenly sees components of the body as foreign and destroys them. Some forms of arthritis are autoimmune diseases, too, but eczema and arthritis are not directly related.

If you haven't already, I would recommend that you see a dermatologist to make sure what you have is truly eczema. In some cases, eczema can be confused with psoriasis, a skin disease in which itchy, scaly, red patches form on the elbows, knees, forearms and other parts of the body. Psoriasis is associated with a form of arthritis known as psoriatic arthritis.

DR. CALABRESE

WHAT ARE GOLD PILLS?
Q. I was recently diagnosed with rheumatoid arthritis (RA) and my doctor wants to prescribe gold pills. Can you tell me what these are, and if they are safe and effective? Do these pills really contain the type of gold that is made into jewelry?

A. Gold compounds do indeed contain real gold, but in a chemical form quite different from that of the gold in jewelry. A good analogy is the iron pills that some people take for anemia are also very different from iron metal – the pills have been altered into a chemical form that can be safely used by the body.

Gold compounds, either in pill or injectable form, are effective for RA. They were the first disease-modifying drugs available to doctors, and until the late 1980s were still the “gold standard” to which newer drugs were compared. More recently, injectable gold compounds have been prescribed less often because they may cause side effects including kidney damage, decreased blood counts and severe skin problems. Gold pills, on the other hand, are safer, but less effective, than their injectable counterparts.

DONALD R. MILLER, PHARMD
Pharmacist

ANKYLOSING SPONDYLITIS AND HEART PROBLEMS
Q. My son, who has ankylosing spondylitis (AS), was recently found to have an extra heartbeat and rhythm abnormalities, which his doctor attributes to the effects of AS. Have you heard of this complication? Is there anything that can be done for it?

A. Heart problems, including irregular rhythm of the heart like an extra beat, do occur in a small percentage of people with ankylosing spondylitis, though they generally occur after many years in those with particularly severe disease.

Some heart problems in people with AS are mild and don’t require treatment, while others can progress to require a pacemaker. I would recommend that your son have a thorough cardiac evaluation to determine if the abnormality warrants treatment at all.

DR. CALABRESE

FIBROMYALGIA AND RESPIRATORY INFECTIONS
Q. Ever since I was diagnosed with fibromyalgia, I have become increasingly susceptible to illness. I have a cold practically all year. Does having fibromyalgia make infectious illnesses more likely?

A. Because immune system abnormalities haven't been found in people with fibromyalgia, I doubt that having fibromyalgia could increase your susceptibility to infections of any kind. Yet having fibromyalgia may make you more sensitive to the discomforts colds cause, so it may seem as if they are more persistent.

If you continue to have frequent colds, consult your doctor to determine other possible causes, such as sinus or allergy problems.

DAVID PISETSKY, MD, PHD
Rheumatologist

WILL EXERCISE HURT HIPS
Q. I have mild OA in my hips that is causing pain, but I don't want to stop walking, biking and hiking. Will strenuous exercise accelerate the damage to my hips?

A. Regular exercise should be good for your hips. But, as with most good things, there are some caveats. If you experience excessive pain during or after exercise, you are probably overdoing it and should cut back on the frequency or intensity of exercise to see if that helps. Of the exercises you mentioned, cycling is the easiest on the hips, while hiking on irregular surfaces or inclines is the most demanding.

DR. CALABRESE

DOES 'MONO' CAUSE RA?
Q. Is rheumatoid arthritis more common in people who have had mononucleosis? Is it possible that the mono virus could trigger RA?

A. As far as I know, there are no studies showing an association between RA and mononucleosis (“mono,” for short). In theory, a virus like the Epstein-Barr virus (EBV), which causes mono, could trigger an autoimmune reaction. But almost every adult has been infected by EBV at some point and, obviously, not everyone has rheumatoid arthritis. For that reason, there must also be genetic factors that make one person more likely to get RA than another, even if EBV is a possible trigger.

DR. ROUBENOFF

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