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Insider Arthritis Tips Newsletter February 2011
February 15, 2011

"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 Degenerative Arthritis
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.

Fostamatinib Safe But Not Effective In Rheumatoid Arthritis Patients Unresponsive To Biologic Agents
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 be safe.

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 biologic therapy.

Lower Back Pain May Be Inherited
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 disc disease."

Comment: If you have teenagers out there, another thing they can blame you for…

TNF Inhibitors Reduce Diabetes Risk
Heidi Splete in Rheumatology News reported that 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 Corticosteroids For 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 recurrent tendinitis.

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 A Woman Who Is Pregnant And On Biologics?
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 for infection. 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 Rheumatoid Arthritis Determined
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 author. 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 Osteoarthritis
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 Center. 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 Replacement

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 dictates recovery…



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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 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.

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