"Failure should be our teacher, not our undertaker. Failure is delay not defeat. It is a temporary detour, not a dead end."
-- Denis Waitley
Reporting Arthritis News For February 2011
Fortified Cheese May
Reduce Bone Loss
In Elderly Women
Laura Dean writing in Medwire
reported, "Consumption of soft cheese
enriched with vitamin D and calcium
could reduce bone loss, and thus long-
term fracture risk, in elderly women
living in nursing homes," according to
a study published in the Journal of
Health Nutrition and Aging. Researchers
"investigated the effect of a nutritionally
enriched soft plain cheese on bone loss
markers in 21 female nursing home
residents," who had "low vitamin D"
levels and a calcium intake "below
700 mg/day." The subjects consumed
cheese "made with semi-skimmed milk,
which was fortified with vitamin D3 and
milk calcium. The researchers
"found that the cheese supplementation
increased the women's calcium
and protein intakes by 51% and 33%," respectively.
Comment: So.. who cut the cheese?
Hand Splints May Ease
Lynne Peeples writing in Reuters reports
that hand splints may ease degenerative
arthritis pain, according to a study in Arthritis
Care and Research. Investigators analyzed
12 studies with about 500 patients. Although
the splints usually did not improve strength
or hand mobility, the splints had an effect on
pain comparable to that achieved with
anti-inflammatory drugs. Notably, in one
study, hand pain was cut by 50% for
patients who wore a rigid splint every
night for one year.
Comment: Helps the hand but cuts down on the romance.
But Not Effective
A report in Science Daily presented the
results of a study published in
Arthritis & Rheumatism In a previous
study, rheumatoid arthritis patients who
failed to respond to methotrexate were
shown to experience positive results
with fostamatinib disodium (R788),
an oral spleen tyrosine kinase (Syk) inhibitor
that is thought to block immune cell
signaling involved with bone and cartilage
destruction. In the current study, RA
patients who failed to respond to biologic
agents were studied. In contrast to the
prior study, however, fostamatinib
was not effective in this group of
patients, although the drug did appear to
Comment: This drug is a member of a
new group of oral drugs for RA.
I’m not surprised by the results of the study since
it’s much harder to get a good response
in patients who have failed previous
Lower Back Pain May
Salynn Boyles of WebMD reported
that in an analysis of a database of more
than two million people, lower back pain may
be inherited. According to a study published
in the Journal of Bone and Joint Surgery, "people
with an immediate family member, such as a
parent, sibling, or child, with disc-related low
back pain were more than four times more
likely to have low-back pain themselves.
More modest increases in risk were
associated with having a second- or
even a third-degree relative with a
diagnosis of herniated or degenerative
Comment: If you have teenagers out there,
another thing they can blame you for…
TNF Inhibitors Reduce
Heidi Splete in Rheumatology News
Use of tumor necrosis factor
inhibitors, drugs that are used to treat inflammatory
forms of arthritis such as rheumatoid arthritis
was associated with a 60% reduction in
the risk of developing diabetes. Researchers
at the Geisinger Clinic in Danville, PA
reviewed data from 1,287 adults with
rheumatoid arthritis. 13 new cases of diabetes
developed in the group who had used tnf
inhibitors while 43 patients in the never used
group contracted diabetes.
Comment: Two birds with one stone.
Bacteria In Mouth
Linked To Rheumatoid Arthritis
Researchers have associated periodontal disease,
or gum inflammation, with RA, although no specific
bacteria have ever been identified by researchers
as the bacteria to target as possible therapy.
Researchers from New York used DNA
amplification technology to identify
what type of bacteria exist in the mouths
of study participants, which included
eight people with newly developed RA,
and nine people without these diseases
who were considered healthy.
One bug strongly implicated
in the pathogenesis of periodontal disease,
Porphyromonas gingivalis, may also be
the trigger for rheumatoid arthritis.
Comment: I guess if you can pronounce it, half
the battle is won.
Should We Stop Using
Local Injections Of
Treatment Of Tendonitis?
Dr. HS Diamond in Medscape reported
On a review of clinical trials
of local corticosteroid injections
(cortisone shots) for tendinitis published in the Lancet
The study found short-term benefits from
local corticosteroid injection but no long-term benefit
He goes on to say…the low toxicity of local corticosteroids
and the rapid pain relief in tendinitis justifies their use
if short-term pain relief is the goal. They may
not be a good choice in patients with chronic or
Comment: I agree… acute moderate tendonitis usually responds
to steroid injections but severe tendonitis as well as chronic tendonitis should be treated with tenotomy and PRP
Arthritis Trigger Found
From the UK's Daily Express we
have this nugget…
Scientists at Imperial College London
have found a protein called IRF5 that
acts as a switch, telling immune system
cells, called macrophages, to promote
or stop inflammation.
Blocking the production of IRF5 could
help in a range of diseases including RA,
lupus and even MS.
A treatment called anti-TNF drugs
developed at the college previously is ineffective in
30 per cent of cases.
Senior researcher Dr Irina Udalova
said: “This is really exciting.”
Comment: I think it is too.
What Do I Do With
Who Is Pregnant And On
Dr. Sunanda Kane at the Mayo Clinic
Recently presented this important
information Biologic drugs are protein antibodies,
and most cross the placenta. They do not
begin to cross until the second trimester,
around week 20 of pregnancy. Maximal
transfer occurs between weeks 30 and
38 of pregnancy. Thus, if a pregnant
woman is on Remicade, we instruct
her to time her last dose around week
30-32 of pregnancy, and then re-dose her
after delivery. Women on Humira should
be instructed to self- inject their doses until
around week 33-34 of pregnancy.
Interestingly, data suggests
Cimzia does not cross the placenta at
all. The above recommendations are for
patients who are in remission.
Experts do not endorse switching biologics
during pregnancy If a pregnant woman
has active RA, then we continue her
biologic therapy. The first trimester has the
lowest risk for transfer of antibodies and
the highest for disease flare. The benefits
of controlling disease outweigh the risks
to the unborn baby.
There does not appear to be any increased
risk for infection following caesarean section
if biologics are given right after delivery,
as long as there is assurance that no placenta
has been retained, which could be a source
Furthermore, there's data to show that
biologics do not cross into breast milk,
so breastfeeding is permitted for women
on most biologic therapy.
Comment: I'd like to add that fortunately, many
women with RA go into spontaneous
remission during pregnancy.
Lifetime Risk Of Adult
From Science Daily, Mayo Clinic
researchers have determined the
lifetime risk of developing rheumatoid
arthritis and six other autoimmune
rheumatic diseases for both men and
women. The findings appeared in
Arthritis and Rheumatism.
"We estimated the lifetime risk for
rheumatic disease for both sexes,
something that had not been done
before," says Cynthia Crowson first
The adult lifetime risk in the
United States of having some
kind of inflammatory autoimmune
disease is 8.4 percent for women and
5.1 percent for men. That means
one woman in 12 and one man in 20 will develop one
of the conditions in their lifetime. The
authors consider that a substantial risk.
Comment: And so do I...
Uric Acid May Increase
Likelihood of Severe
Mary Jane Gore writing for the Duke
University News reported that the
amount of uric acid in one's joints
may increase the likelihood of severe
osteoarthritis, the most common form
of arthritis worldwide, according to
researchers at Duke University Medical
Osteoarthritis is a debilitating joint
degeneration for which no drug has
been proven to slow or halt its progression.
Physicians can only offer to treat the
symptoms associated with osteoarthritis,
and people with the condition are
often subject to a reduced quality of life.
Dr Virginia Byers Kraus senior author
of the study published in PNAS, stated,
"This research is a step towards identifying
uric acid as a risk factor for osteoarthritis."
The researchers looked at 159 people,
who had knee osteoarthritis but no history
of gout, a type of arthritis triggered by uric
acid crystals in the joints. The researchers
found the severity of osteoarthritis in their
knees to be strongly correlated with the
amount of uric acid in their knees.
Comment: Good stuff to know!
Immune Disorders Increases
Risk Of Blood Clots
Robert Preidt writing in Newsday reported a
study published in BMC Medicine showing
People with immune-related disorders such
as rheumatoid arthritis and lupus may be
at increased risk for developing potentially
deadly blood clots during hospital stays,
a new study has found.
Researchers at the University of Oxford in
the UK analyzed 45 years' worth of medical
records of patients who were hospitalized
for immune-related disorders and had no
evidence or prior history of blood clots in a
vein, also called venous thromboembolism
-- one type of which can break off and travel
to block a blood vessel in the lungs.
The patients were divided into different groups
based on their immune-related condition.
The researchers then compared them to
patients who were hospitalized for minor,
non-immune-related problems such as
broken bones and minor surgical procedures.
The investigators found significantly
elevated rates of blood clots in the veins
of people with certain immune diseases s
uch as rheumatoid arthritis and lupus.
Principal investigator, Dr. Michael
Goldacre and his colleagues suggested
that inflammation caused by immune
disorders may increase the tendency of
blood to clot.
Comment: Patients with autoimmune
disorders need to be aware.
Personal Motivation May
Affect Timing Of Return
To Work After Total Knee
Robert Preidt writing in Newsday,
reported, "personal motivation plays
a major role in how quickly a person
returns to work after a total knee
replacement," according to a study
published in the Journal of Bone
and Joint Surgery. The study involving
"162 people who had full- or part-time
jobs or were self-employed found that
the median time it took people to go
back to their job after a total knee
replacement was 8.9 weeks." Some
factors predicting "an earlier return to
work after knee replacement included:
being female, having a job that was less
physically demanding, being self-employed,
being employed at a workplace...accessible
to people with disabilities and having a
stable emotional state before surgery."
Comment: So… the power of the mind
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Wei's World February 2011
In a previous newsletter, I talked about our second child’s graduation from New York University’s Tisch School of the Arts with a major in musical theater. Ever since he was two years old, just barely able to run around, Jeffrey was enamored with singing, dancing, and acting. Initially, we thought it was a cute phase he was going through, but the phase never ended. His dream, his passion, has always been to perform on Broadway.
Students who go through CAP 21, the musical theater program at Tisch, participate in a practicum. This is a semester long program that prepares the students for the real world… how to make the most of their talents, how to deal with agents, and so on. The practicum culminates in a showcase where the entire class performs individually in front of agents with the hope that this will result in a signing.
Obviously, it’s a huge deal. Getting signed with an agent is a major step in securing work in the performing arts. Jeffrey has been rehearsing for this showcase for several months. He has been very nervous.
The nice thing about the CAP program is that they allow the parents and relatives of the students to attend a dress rehearsal before the students perform in front of the agents.
So, this past Tuesday, my wife and I along with our other son, Benji, drove to New York City to attend the dress rehearsal.
New York was under a winter storm warning with a foot or more of snow predicted but that wasn’t going to deter us from seeing Jeffrey perform. We were able to grab a quick bite before the show and then went to the theater to watch.
What an amazing display of talent! You have to understand that the musical theater students at Tisch are arguably among the best performing arts students in the country. These kids are the best of the best. And the performances were simply astonishing.
After the show, we took Jeffrey out for a bite to eat. He was clearly nervous and worried about the eventual outcome. He said that sometimes students in this showcase aren’t signed by any agent. This could understandably smash a student’s ego. My wife and I did our best to tell him that no matter what, he needed to continue to follow his dream.
We reminded him of what was once said about Fred Astaire after an audition by an agent: "Can't sing. Can't act. Balding. Can dance a little."
Let’s face it, in life we all face our share of disappointments and frustrations. Persistence and belief in yourself can go a long way in becoming successful.