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Insider Arthritis Tips Newsletter December 2010
December 15, 2010

"Do the thing you fear, and the death of fear is certain."
-- Ralph Waldo Emerson, Poet

Arthritis News From November 2010

Enbrel May Help Improve Growth In Children With Juvenile Arthritis
Katrina Woznicki writing for WebMD reported that, according to a study published in Arthritis & Rheumatism, "a drug used to treat inflammatory arthritis increased growth rates among children with juvenile arthritis, a disease that affects children's joints and can stunt their growth." In a study comparing treatment with Enbrel, methotrexate, or Enbrel plus methotrexate " among 594 children ages two to 18 with juvenile arthritis," researchers found that "overall, the children taking Enbrel or Enbrel plus methotrexate experienced steadily increasing improvements in height, weight, and BMI compared with those who took methotrexate alone."

Comment: I found this article really hit home because one of my children developed juvenile arthritis at the age of 10. He was put on Enbrel and is now 20 and doing well.

FDA Approves Cymbalta To Treat Musculoskeletal Pain
Catherine Larkin writing in Bloomberg News reported, "Eli Lilly won approval to sell the antidepressant Cymbalta as a treatment" for "musculoskeletal pain such as arthritis and chronic lower back conditions. "Up to three-quarters of the population experience chronic pain at some time in their lives," Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research, said in the statement. "This approval means that many of those people now have another treatment option." The drug is also approved for depression, and for treatment of diabetic peripheral neuropathy, generalized anxiety disorder, and fibromyalgia."

Comment: I’m not sure where this medication fits in for my patients but at least it’s an option to think about.

Pfizer Competes To Sell First New RA Biologic Pill
Tom Randall writing in Bloomberg News reported that Pfizer Inc. "is competing against three rivals to sell the first new pill in a decade for rheumatoid arthritis." The drug, "called tasocitinib, stopped inflammation and kept the disease from worsening" in a trial including 611 patients, "Pfizer reported last week. Pfizer may edge out drugs such as Enbrel, Humira, and Remicade, drugs given by injection, if research suggests its tablet is also a safe alternative." Bloomberg News points out that "tasocitinib is the most advanced pill in a family of experimental drugs to target a protein, called JAK, which leads to joint destruction in 1.3 million Americans with" RA. However, the Pfizer study also indicates the drug had side effects, which were reported by 330 patients, and 25 of reports of which were serious.

Comment: This is an important development… we’ll see what happens. The meds for RA continue to evolve.

New RA remission criteria unveiled

New criteria to define clinical remission in rheumatoid arthritis, endorsed by the American College of Rheumatology and the European League Against Rheumatism (EULAR), provide a realistic standard for drug trials and give clinicians a better guide for treating patients, researchers said recently. The new criteria define remission as no more than one swollen joint and one tender joint, a C-reactive protein (CRP) level of no more than 1 mg/dL, and a Patient Global Assessment score of no more than 1, said David Felson, MD, of Boston University, co-chairman of the ACR-EULAR committee that developed the standard.

Comment: Some guidelines that might be helpful, particularly when talking with patients about remission and whether they’re in it.

Low Salt Levels, Fracture Risk
Randy Dotinga writing in HealthDay reported that "lower- than-normal levels of sodium (salt) in the blood" may be linked "to a higher risk of broken bones and falls in older adults," according to a study presented at the American Society of Nephrology's annual meeting. Investigators looked at data on approximately 5,200 individuals older than 55. The researchers found that "a quarter of the people with low sodium levels had falls, compared to 16 percent of the others in the study, and their risk of vertebral/vertebral compression fractures was 61 percent higher. The risk of non-spinal fractures, such as broken hips, was 39 percent higher."

Comment: Low sodium can affect brain functioning and certainly affects balance and muscle function. It’s an important issue particularly in elderly patients with multiple medical problems.

Darvon, Darvocet Painkillers Pulled From Market Over Heart Risks By FDA
Andrew Zajac writing in the Los Angeles Times reported, "The maker of Darvon and Darvocet announced that it will stop marketing the widely used painkillers in the US because of a new study linking the active ingredient in the drugs to serious and sometimes fatal heart rhythm abnormalities." Xanodyne Pharmaceuticals Inc. "agreed to the ban at the request of the Food and Drug Administration, which also asked makers of generic versions of the drugs' core compound, known as propoxyphene, to stop selling it in the US."

Comment: Those of us who did our medical training in the 1970’s always used this medicine for pain relief because we thought it was safer than other pain killers. I guess not. We’re left with a void though between Tylenol and harder narcotics.

Stem Cells For Osteoarthritis of the Knee
I presented a talk at the American College of Rheumatology meeting in Atlanta on November 8, 2010. The presentation was entitled, Guided Mesenchymal Layering Technique in the Treatment of Osteoarthritis of the Knee.”
The talk outlined our experience with the initial 22 patients who’ve undergone the stem cell procedure for osteoarthritis of the knee. I’ll give you the thumbnail sketch of the talk.
There were 4 treatment failures, defined as patients who had no significant clinical response by three months. One person died from an unrelated issue, and one person lived in another country and was unable to come back for the clinical measurements.
Of the 16 patients who were considered responders, subjective measures of clinical improvement (Patient Visual Analogue, Physician Visual Analogue, Patient 50 Foot Walk, WOMAC) as well as objective ultrasound measurement of cartilage thickness showed marked statistical improvement. While this was an uncontrolled study, the data suggests the need for more investigation.

Comment: The striking finding was the increase in cartilage thickness. This is the first time that I'm aware of that a prospective look at a population of patients in a rheumatology practice has evaluated stem cell technology for OA of the knee. Perhaps... someday, we can make joint replacement surgery a thing of the past.

A quick reminder:

Visit our new practice website. The address is: Arthritis Treatment Center Lots of good info and a daily video blog with really good stuff.


I am pleased to announce the launch of three books that I have recently written… to help you manage your arthritis!

  • The Book on PRP
  • The Book on Stem Cells for Osteoarthritis, and
  • The Book on Arthritis

Your special introductory offer will be $5.00 off the retail price, and autographed by me. Your loved ones will appreciate this as a gift! Hanukah, Kwanza, or Christmas Stocking Stuffer!!

You can discover….

  • Why poking holes in a tendon is absolutely important to getting results with PRP. Sounds crazy but it’s true!
  • How many platelets do you really need to get the result you want? The failsafe, flawless method for delivering PRP… If your doctor isn’t using this, run the other way!
  • Which one off these 7 arthritis risk factors do you have?
  • The one critical reason why you should never take this powerful drug for arthritis!
  • Relieve back pain without medicines. Six natural remedies will spare you a trip to the doctor.
  • The first sign of knee arthritis that should make you think of stem cells immediately… do you know what it is?
  • Who’s the best candidate for stem cells… and who’s the worst… find out now!

The Book On PRP - Was 14.99, Now 9.99

The Book on Stem Cells for Osteoarthritis - Was 14.99, Now 9.99

The Book on Arthritis Treatment - Was 29..99, Now 24.99


Wei's World December 2010

In November, I had an interesting experience.

I had the opportunity to film a PBS special on arthritis in Daytona Beach, Florida. The show will air sometime in the early spring. I’m told it’s going to be a national show so look for it!

I had never done anything like this before. Sure… I had been on TV shows… but it was always an interview type of situation with not a lot of preparation needed. I basically had to show up and answer the questions I knew were going to be asked of me.

This was different. While I knew what many of the questions were going to be, I had to prepare tightly scripted answers that had to fit in with the rest of the show.

I had the good fortune to work with two real professionals, Suzanne Andrews, an occupational therapist, and Dr. Mache Seidel, a professor of medicine at the University of Massachusetts Medical School.

I didn’t realize the amount of work and effort involved in filming for television. The scripts are tightly edited and you have to be on your Ps and Qs … you really need to know your stuff. The preparation is amazing. You have make-up people and costume check people who make sure what you’re wearing is going to look good. There are microphone check people, camera people, on floor directors, off floor directors, producers, “go-fers”, and so on.

The make-up part was particularly interesting since they have to go for different types of looks and different types of lighting and back drops.

You might term it organized chaos.

The show was shot in segments so that the pieces could be edited and put together later. Every movement was choreographed. If a mistake was made, we could redo that. Teleprompters certainly helped. Because I was working with a professional crew, the number of “do-overs” was minimal. Thank goodness since we were operating on a tight time budget. Both Dr. Seidel and I had to get back to the office to see patients.

And it made me think about the similarities and differences between television show production and medicine. Having everything choreographed and laid out so it would flow is exactly the way medicine should be. That would certainly help eliminate errors. We already do much of that in our practice. We train and rehearse and talk about how things should flow and what activities might make for a better patient experience. The big difference though is this… there are no do overs. No second takes. We’re “live” all the time.

And that’s a huge difference, particularly when it comes to procedures.

My big take-away lesson:

In medicine, there are no do overs. That’s why practice and rehearsal before you see patients is mandatory. And it doesn’t stop in medical school. It’s got to be constant and ongoing.

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