"In prosperity our friends know us; in adversity we know our friends."
-- John Churton Collins
Reporting Arthritis News For April 2011
Gout Flares In Study
Meg Perrell writing in Bloomberg
News reported, Regeneron
Pharmaceuticals "said its
product," Arcalyst (rilonacept),
helped "prevent gout flares in a
late-stage study of patients
starting therapy to lower uric
acid levels." Rilonacept, also
known as IL1TRAP, is a
protein antibody that binds a
nother inflammatory protein
called interleukin 1.
Interleukin 1 is said to be
the inflammatory instigator of
gout flares. Study participants
who were given weekly injections
of Arcalyst over four months
had a decrease of 72 percent in
gout flares compared with placebo."
Incredibly expensive treatment…
For Injured Joints, Tendons
Jane Brody writing in the New York Times
reports that clinical trials are questioning
the effectiveness of corticosteroid injections
and resting an injured joint for an injured
tendon. For example, a review of "41
'high-quality' studies involving 2,672 patients,
published in November in The Lancet, revealed
only short-lived benefit from corticosteroid
injections. For the very common problem of
tennis elbow, injections of platelet-rich plasma
derived from patients' own blood had better
long-term results." Still, the authors noted
that more and better clinical research is
needed to "determine which among the
many suggested remedies works best for
treating different tendons."
Comment: Bottom line is PRP works.
Bunions as common as onions?
Dr Laura Martin writing in WebMD
reported, "Bunions -- deformities
at the base of the big toe that can
cause pain and disability -- are common
and can really slow a person down,"
according to a study published in Arthritis
Care & Research. For the study, "researchers
in the UK surveyed more than 2,800 people
ages 56 and over" and found that bunions
were "about twice as common in women
as in men, and that the likelihood of having
a bunion increased with age. Overall,
about 28% of people ages 50 to 59 reported
having bunions, compared to nearly 56%
of people over age 80."
Comment: That’s a lot of bunions!
Virus ruled out as cause of FM
Sally Koch Kubetin writing in Rheumatology
News reported that
Xenotropic murine leukemia virus-related
–whew what a mouthful – often shortened
to XMRV- has been touted as a possible
cause of fibromyalgia.
Researchers at the Hospital; Universitario,
Madrid compared blood from 15 patients
who met the American College of Rheumatology
diagnostic criteria for fibromyalgia and 10 healthy
controls. They screened using a DNA extraction
and polymerase chain reaction. They failed
to find evidence of XMRA in the blood.
Comment: There goes another theory…
Blood injection works
for hamstring injuries
Susan Birk writing in Rheumatology News
reported a study from the Royal National
Orthopedic Hospital in London. Investigators
used ultrasound guided dry needling and autologous
blood injection to treat hamstring tendonitis. The 42
patients, all athletes, were randomized into one of
three treatment groups. One group received
steroid injections, another group received
autologous blood- about 2-3 cc’s, and the third
received both. The injections were ultrasound
guided. All the patients then underwent physical
therapy for 6 weeks three weeks after the treatment.
Significant reductions in pain and improved function
scores were seen in the steroid plus blood group
followed by the blood only group. The steroid patients
were better at 6 weeks but then declined thereafter.
Ultrasound evaluation at 3 months showed healing
in both blood groups and persistent microtearing
in the steroid only group.
Comment: More ammunition for PRP use!
For Vertebral Fracture
Reduces Pain, Improves QOL
Laura Dean writing in Medwire
"Balloon kyphoplasty for vertebral fracture
rapidly reduces pain and improves function,
disability, and quality of life (QoL) over the
course of two years, compared with
non-surgical management," according to a
study published in Journal of Bone and
Mineral Research. This type of fracture
often cause severe pain between the shoulder
blades. Researchers used the
"100-point short-form (SF)-36 physical
component summary (PCS) score to assess the
patients' physical ability at regular intervals
through the study period." They found that
improvement in the "SF-36 PCS score from
baseline over the 24-month period was, on average,
3.24-points higher among patients in the balloon
kyphoplasty group compared with those
in the non-surgical care group ."
Comment: This is a procedure that has come of age
Uric Acid: A new
predictor for Heart
Eswar Krishnan and Jeremy
Sokolove in the journal Current
Opinion in Rheumatol.
reviewed the recently published
data on elevated blood uric acid
levels and cardiovascular disease.
Evidence has accumulated in
prospective observational studies
that link hyperuricemia with the
risk of hypertension. Newer
data confirm the link between
hyperuricemia and cardiovascular
mortality. The use of allopurinol
has been shown to be associated
with reduced mortality risk and
with reduced blood pressure in
short-term randomized controlled trials.
The available evidence has established
a link between hyperuricemia and
cardiovascular disease and this may
Comment: One can start using serum
uric acid concentration as an
inexpensive cardiovascular risk marker.
Gout and elevated blood uric acid
which leads to gout is increasingly
rapidly in the United States. Gout
prevalence increased by 1.2% over the
past 20 years, affecting 8.3 million
Americans according to the most recent
data from the National Health and
Nutrition Examination Survey.
Researchers say it is because of the
increasing frequency of obesity as
well as other metabolic problems
such as hypertension, chronic kidney
disease, and diabetes.
Comment: Another problem associated with the obesity epidemic!
Early Rehabilitation May
Help Speed Recovery From
Robert Preidt writing in HealthDay reported,
"The sooner rehabilitation begins after knee
replacement, the better for both patients and
hospitals," according to a study in the journal
Clinical Rehabilitation. The researchers
"compared more than 150 patients who
began rehabilitation within 24 hours after knee
replacement surgery and a matched control
group of patients who began rehabilitation 48 to
72 hours after surgery." They found that on average,
patients "who started rehabilitation earlier
spent two days less in the hospital and had five
fewer rehabilitation sessions before they were
discharged than those in the control group."
Comment: Makes sense to me!
Back Pain Genetic
Anahad O’Connor writing in the
New York Times reports that "a
growing number of studies are
finding that chronic back pain has
a strong genetic component."
For example, an analysis published
in the Journal of Bone and Joint
Surgery, based on records from a
"large health and genealogic
database to study more than a
million Utah residents," found
that having a "second-degree
relative (aunt, uncle or grandparent)
or third-degree relative (cousin)
with the condition increased a
person's risk, regardless of
environmental factors." Moreover,
the data indicated that having
"an immediate family member
raised a person's risk more than
There are some family get togethers
that are less fun than others.
Gout Increasing In US
Arthur Allen, author of "Vaccine:
the Controversial Story of Medicine's
Greatest Lifesaver" writing in the
Washington Post, notes that
to recent surveys, cases of gout in
the US have "roughly tripled since
the late 1970s," with about "8-million
Americans" now suffering from the
condition. Allen suggests the increase
may be attributed to a "number of
lifestyle changes. First, we are awfully
'easy in our circumstances,' in the sense
that most of us can afford cheap animal
protein, alcohol and sweet" beverages.
Moreover, paradoxically, we are seeing
increased life spans. Lastly, some
of the drugs that "keep older Americans
alive despite high blood pressure,
kidney disease and other conditions,"
such as niacin, thiazide and loop
diuretics, have also been shown
to "raise bloodstream levels of uric acid."
Comment: The disease of kings is now the disease
With a TNF Inhibitor
and Methotrexate Safe
Any More Effective
ScienceDaily reports a recent trial
of rituximab in combination with a t
umor necrosis factor (TNF) inhibitor
and methotrexate (MTX) in patients
with active rheumatoid arthritis (RA)
found the safety profile to be consistent
with other RA trials with TNF inhibitors.
While the trial reported no new safety risks,
clear evidence of an efficacy advantage in
RA patients receiving the combination
therapy was not observed in this study sample.
Results of the trial are published in
Arthritis & Rheumatism
Sometimes what makes sense doesn't.
Need Exercise: Get a dog
Tara Pope-Parker writing in the
New York Times
Reported that several studies now
show that dogs can be powerful
motivators to get people moving.
Not only are dog owners more likely
to take regular walks, but new research
shows that dog walkers are more active
over all than people who don’t have dogs.
One study even found that older people
are more likely to take regular walks
if the walking companion is canine rather than human.
“You need to walk, and so does your
dog,” said Rebecca A. Johnson, director
of the human-animal interaction research
center at the University of Missouri
College of Veterinary Medicine.
“It’s good for both ends of the leash.”
Researchers at the Michigan State University
reported that among dog owners who took
their pets for regular walks, 60 percent
met federal criteria for regular
moderate or vigorous exercise. Nearly
half of dog walkers exercised an average
of 30 minutes a day at least five days a
week. By comparison, only about a
third of those without dogs got that much
Comment: Woof woof!!
Bruno Oliveira, a rheumatologist,
writing in Medscape reported on
growing evidence suggesting that
Nitroglycerin in the form of ointment
works for Osteoporosis. A study in
JAMA showed additional data
supporting this claim.
Nitroglycerin treated subjects
showed (at 2 years) a 6.7% increase
in bone mineral density at the lumbar
spine and 6.2% increase at the total
hip. Bone quality seemed to be
improved as well Nitroglycerin
treated subjects experienced
more headaches as expected.
An inexpensive remedy that works.
Comment: Sounds promising.
Bath salts aren't just good for the body; they're also good for the mind.
Bath salts help heal many ailments and can help you relax. They offer many added
benefits that you might not expect to get from something as simple as tossing a
little salt into your bath. For reducing pain, repairing damaged skin, and
literally washing away stress, bath salts have many healing properties.
Bath salts, mixed with essential oils, can help promote greater relaxation. A
leisurely soak in a nice warm bath with a scented salt can actually help reduce
your level of stress.
You will feel rejuvenated and better able to cope
with life’s demands once you are no longer overwhelmed by anxiety and pressure.
You will be able to concentrate better and think more clearly when you allow
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Take your bath an hour or so before
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A quick reminder:
Visit our practice
website. The address is: Arthritis Treatment Center
Lots of good info and a daily video blog filled with really good stuff.
Wei's World April 2011
I was recently invited back to my medical school, the Jefferson Medical College in Philadelphia. For those who don't know about Jefferson, it is the oldest private medical school in the country and one of the most venerated.
My attending Jefferson for medical school was not by chance.
My mother was instrumental not only in my going into medicine (my birthday gift as a 4 year old was a doctor's kit… no subtle hint there!) , but also in my choosing to go to Jefferson.
We lived in the outskirts of Philadelphia during my growing up years. As a child, I had bad asthma and saw an allergist on a regular basis. If I remember correctly, he was a Jefferson grad and a real fan of the medical school. Also, everyone my mother talked with about medical schools did the same.
In Philadelphia, the University of Pennsylvania might have more "prestige" because it's an Ivy League school, but those in the know knew that Jefferson was the pinnacle of medicine in Philadelphia.
So my fate was sealed.
And I will be the first to admit that my time at Jeff was tremendous. Their mission is to educate and treat clinicians and they do their job superbly.
So, anyway, let’s get back to my visit...
It was amazing! Not only had the medical school campus increased in size about ten-fold since my days there, but they also had new developments that just took my breath away.
One building that was particularly impressive was the pristine Clinical Simulation Center building.
In the old days when I was going through med school, you spent the first two years in classrooms learning things like biochemistry, histology, anatomy and so on. Very dry and nothing to do with patients. That is why medical school was so hard… at least then. You studied all this science and wondered what the application was to taking care of patients.
With the new Clinical Simulation Unit, students are taken on the second day of classes to this building to practice their interview and examination skills on actors who are specially trained to behave as if they have real diseases. In addition they get to practice procedural skills on dummy patients. The students learn to correlate basic science theory with real world patient care immediately!
And everything is state of the art. They had real set ups for hospital rooms, intensive care units, and even operating suites. All connected by the way with cameras and other media so a student could be observed and critiqued from a remote location.
The clinical simulation unit is so popular that even attending physicians, fellows, and residents use it to hone their skills! Awesome!
There have been many times when I wished that my medical school experience could have been more like what I saw at Jeff that day.
Another unexpected pleasure… I went back to my old lecture hall and got to sit in the same seat I sat in forty years ago. Funny how the auditorium seemed smaller than I remembered. Sort of like going back to your elementary school. The hallways so much narrower than you recall.
Another treat…I got to see a classroom of students.
When I went to medical school, there were only a few women and very few minorities. Now the class is about fifty per cent women and there are minorities well represented.
The future is bright for medicine, I think.