To look at paintings by Pierre-Auguste Renoir, you would never guess how much it cost the famous French Impressionist to create them. The soft light and gentle colors of landscapes, still lifes, and portraits - particularly children and full-figured, beautiful women - convey an effortless beauty that camouflages the painful and difficult truth.
This towering art-world figure spent the last 25 years of his career hunched in a wheelchair, doing daily battle with the grinding pain and growing immobility caused by rheumatoid arthritis. Yet he continued to paint until his death in 1919, at age 78.Fourteen years ago, when Dr. James Louie, chief of rheumatology at the Harbor-UCLA Medical Center in Los Angeles, learned about Renoir's affliction, he became intrigued by the grit of the artist.
"You have no idea when you look at his paintings or his subject matter that he had this bad disease," Louie says.
Arthritis, he says, is the symptom or sign that reflects more than 100 different ailments of the immune system. According to the Arthritis Foundation, it is America's No. 1 crippling disease, afflicting one out of seven people, young and old alike.
The chief symptom is swollen, painful joints that eventually become all but immobilized. Pain and swelling are caused by uncontrollable growing of a layer of cells, the synovial tissue lining the joint, explains Louie. "It grows like cancer and destroys the joint. That's why you get ligament and bone problems."
The typical course of the disease is slow, yet insidious.
"Many people begin to get pain and swelling in small joints - the hands, wrists and feet, in a symmetrical distribution," explains the internist, who took extra years of training for his specialty. "It usually starts on one side, then settles in on both sides.
"About 10 percent of all arthritis patients end up in a bed or a wheelchair; another 50 percent end up with significant problems," Louie says from his Los Angeles office. "About 50 percent cannot work within 10 years."
Renoir, he says, had a very, very severe form of rheumatoid arthritis. "He was diagnosed in his mid-40s, a little bit later than most people are diagnosed."
Today, although medicine has made enormous strides in some disease areas, little is known about either preventing or curing arthritis in its many variations. Symptom management is the most common response, through anti-inflammatory drugs, either with steroids or without.
"In Renoir's day, medicine was less effective at stopping pain and slowing the advance of disease," says Louie. "Renoir did everything they told him, but they couldn't do much."
Dr. James Ravin, a Toledo opthalmologist whose book, "The Eye of the Artist," cowritten with Dr. Michael F. Marmor (publisher Mosby-Mirror), mentions Renoir in a chapter entitled "The Medical Tribulations of an Impressionist."
His research indicated that treatments available in Renoir's day included oral antipyrine (an anti-inflammatory drug similar to aspirin) plus sunshine, walks, massage, baths, purges, heat applications, and spas. "A surgeon frequently scraped at his rheumatoid nodules," Ravin wrote.
Photographs of the artist taken during his last decades make painfully clear the degree of deformity with which he had to contend.
The painter's son, filmmaker Jean Renoir, wrote: "His hands were terribly deformed. Rheumatism had cracked the joints, bending the thumb toward the palm and the other fingers toward the wrist.
"Visitors who weren't used to it couldn't take their eyes off this mutilation. Their reaction, which they didn't dare express, was: `It's not possible. With those hands, he can't paint these pictures.' "
The artist who had challenged critics by asking, "Why shouldn't art be pretty? There are enough unpleasant things in the world," simply refused to let his debilitating ailment prevent him from doing his work.
Gripping his paintbrushes in bandaged hands and guiding one arm with the other while seated in front of a canvas, Renoir painted and painted.
Ironically, according to Dr. Ravin's research, eight years before his rheumatoid arthritis began to appear the painter had broken his right arm in a bicycle accident. The ambidextrous Renoir simply switched his brush to his good hand and continued painting.
"I am enjoying working with my left hand," he wrote to a friend. "It is very amusing and it's even better than what I would do with the right. I think it was a good thing to have broken my arm; it made me make some progress."
Looking at Renoir's long and prolific creative career, Dr. Louie says, "I think painting gave him his reason for life. He did all this work through the pain - what he must have felt. Yet he had this joy and love of life. I say, man, that guy was incredible."
The physician's respect for Renoir's spirit led him to create a slide presentation on the artist, complete with images of Impressionist paintings and of the artist in the final decades, hard at work.
"I go through not only Renoir's story but also explain these factors about rheumatoid arthritis and the elements that define outcome," he explains.
"The point of it all is to say that people who have chronic diseases are basically responsible for managing their symptoms. Doctors are there to help them, but the more understanding we can be, the more effective are the therapies."
Dr. Louie says more arthritis is diagnosed today than in Renoir's day. In part that's due to better methods of diagnosis but also, ironically, the rise in arthritis can be traced to modern medicine's success in treating other diseases.
"Our immune system was put there by God for us to fight off infections," explains Dr. Louie. "Now we have gotten to a state where we can fight off disease so well we develop diseases from this reaction."
Today the most common treatment for arthritis symptoms is one of many anti-inflammatories: steroids or non-steroidal compounds such as aspirin and ibuprofen, or newer preparations such as naproxen, ketoprofen, and paracetamol.
None are risk-free, as a recent Stanford University study showed, documenting the widespread risk of severe or fatal gastric bleeding from these medicines. Moreover, commonly prescribed antacids and acid-blockers may mask early warning symptoms of this serious side effect.
Dr. Louie says alternative and complementary medicine may offer worthwhile treatments for this debilitating disease, but he wants to see results from scientific testing before prescribing them for his patients.
The Los Angeles doctor is collaborating with Dr. Esther Sternberg, a neuroimmunologist at the National Institutes of Health, on a study of mind-body factors affecting arthritis, he says. "There are control mechanisms in the brain for the immune processes that lead to arthritis," he says. Dr. Louie has included material on Renoir in the project.
"Renoir lived at a time when there were ineffective therapies," Dr. Louie says. "But he knew he had to exercise. Later on he needed equipment to help him do his work, and he made it. He was really aggressive at saying, `I have this disease; what do I do to help myself?' That's what is inspirational. He knew what he had to do."
Dr. Louie also lectures on other artists who had diseases of the connective tissue, including Peter Paul Rubens, who died of gout.
(Distributed by Scripps Howard News Service)