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Insider Arthritis Tips Newsletter June 2011
June 15, 2011

"We may encounter many defeats, but we must not be defeated." -- Maya Angelou, poet

Reporting Arthritis News For June 2011

Even Short-Term NSAID Use Risky in Heart patients
Megan Brooks writing in Medscape Medical News reported “In patients with prior heart attack, most nonsteroidal anti-inflammatory drugs (NSAIDs), even when taken for as little as 1 week, are associated with an increased risk for death and recurrent MI, new observational data indicate. Use of NSAIDs was associated with a 45% increased risk for death or recurrent heart attack in the first 7 days of treatment and a 55% increased risk if treatment continued to 3 months. The findings were published in Circulation. "We found that short-term treatment with most NSAIDs was associated with increased and instantaneous cardiovascular risk," stated first author Anne-Marie Schjerning Olsen, MB, from Copenhagen University in Hellerup, Denmark.

Comment: So which is it? Your aches and pains or your heart? Sure is a scary thing.

About Half Of Osteoporosis Patients Find The Decision To Take Medication After Fragility Fracture "Difficult"
Laura Dean writing in Medwire reported, "Just under half of osteoporosis patients find the decision to take medication following a fracture is not an easy one," according to a study in the journal BMC Musculoskeletal Disorders. For the study, researchers "conducted an analysis among six men and 15 women aged 65-88 years, who had sustained a fragility fracture within the previous five years." Nine subjects "reported greater difficulty making their decision; they needed time to think and took several factors into consideration when making their choice. The team observed that these patients were unconvinced by their healthcare provider, engaged in risk-benefit analyses using other information sources, and were concerned about side effects."

Comment: Whew: In my mind, after seeing the pain of an osteoporosis related fracture and knowing these fractures can lead to nursing home placement and death, I don’t understand the findings of this study.

RA Treatment With Rituximab May Carry Modest Risk Of PML
Crystal Phend writing in MedPage Today reported, "Rheumatoid arthritis treatment with rituximab (Rituxan) carries a modest risk of progressive multifocal leukoencephalopathy (PML) at approximately one case per 25,000 individuals treated," according to a study published online in the Archives of Neurology. "Four such cases in an estimated population of 129,000 exposed to rituximab for rheumatoid arthritis were reported by" the researchers.

Comment: PML is a progressive fatal illness where your brain turns into soup… not a pleasant way to go.

PPIs May Boost Fracture Risk
Matt McMillen writing in WedMD reported, "Long-term, regular users of drugs known as proton pump inhibitors such as Nexium , Prevacid, Prilosec , and Protonix appear to have a heightened risk of fractures," according to a study published in the Annals of Family Medicine. Maureen Salaman writing in HealthDay reported Dr. Chun-Sick Eom, a clinical instructor in the Department of Family Medicine at Hallym University Hospital in Chuncheon, Korea, and colleagues, conducted "a meta-analysis of 11 studies published between 1997 and 2011 found that proton pump inhibitors (PPIs), which reduce stomach acid production, were associated with a 29 percent increased risk of fracture. This included a 31 percent higher risk of hip fractures and a 54 percent heightened risk of vertebral fractures."

Comment: Another dilemma. Reflux or a broken hip… you be the judge. Sometimes I think crawling into a cave might be the best option.

Approximately 58,000 Patients Every Year In US May Wake Up With Stroke Symptoms
Mary Brophy Marcus writing in USA Today reported, "One in seven strokes happens at night, and sufferers may not get medicine that could prevent brain damage, suggests a new study" published in Neurology. Investigators "analyzed data from 1,854 patients over 18 who had been treated in hospital emergency departments in Greater Cincinnati and Northern Kentucky over the course of a year for ischemic strokes." The researchers "found that 273 patients experienced wake-up strokes."

Comment: A very typical pattern that hasn’t changes since I was a medical student. Why this time of the day… who knows?

More Americans Developing Gout
Jane E Brody writing in the New York Times reported, "More than six million adults in the United States have had" gout, "and the numbers are rising steadily as the population ages, becomes heavier and is exposed to foods and other substances that can precipitate the disorder in susceptible people." The risk of gout is "higher among people with disorders that are increasingly common in modern society, including hypertension, diabetes, high cholesterol, atherosclerosis and congestive heart failure." Sometimes in the elderly, "especially women, multiple joints can be involved, leading to a mistaken diagnosis of rheumatoid arthritis."

Comment: Mistaking gout for rheumatoid arthritis is a common problem. They can look identical.

Experts Note Lack Of Research On Pregnant Women With Physical Disabilities
The Associated Press reported that "while the vast majority of women with disabling conditions appear to have healthy babies, specialists say far too little is known about moms' risks of complications, their special needs and barriers to good care." Over one "million women of childbearing age have a physical disability - meaning they report needing some sort of assistance with daily living because of such conditions as MS, rheumatoid arthritis, spinal cord injuries or cerebral palsy, says a recent report in the journal Obstetrics & Gynecology." However, "when the National Institutes of Health convened experts to examine the issue, they couldn't even find a good estimate of how many of those women give birth each year."

Comment: This is a significant population of women that has been ignored in medicine.

Study Suggests Milk, Vitamin D Better Option Than Drugs
Debra Pressey in the Urbana/Champaign Illinois News Gazette reported that a new University of Illinois study indicates that Americans at risk for osteoporosis should "consider reaching for the milk before you reach for the medicine. Study authors Karen Plawecki, director of the UI dietetics program, and UI nutrition Professor Karen Chapman-Novakofski, said doctors can be quick to prescribe bone medications because they think people won't change their diets. But they encourage people to try pumping up their daily intake of calcium and Vitamin D first." The article noted FDA concerns about bisphosphonates and that it "warned long-time use of bisphosphonates may be linked to an atypical thigh fracture."

Comment: Probably a good idea to give patients who’ve been on a bisphosphonate for 5-7 years a drug holiday

Older Residents In Rural Areas More Likely To Have Certain Surgeries Than People In Cities
Lindsey Tanner writing for the Associated Press reported, "A surprising study of nearly 46 million Medicare patients says older residents in rural areas are more likely to have any of nine common surgeries than people in cities." The study, published in the Archives of Surgery, found that "back surgery, hip and knee replacements, and prostate removal were among the operations performed more often in rural Medicare patients." The findings "seem to challenge the idea that city dwellers have better access to medical care, but experts say the research raises more questions than it answers."

Comment: Is it better care or not?

Llama Treatment For Rheumatoid Arthritis
John Martens writing in Bloomberg News reported, "Ablynx NV, the developer of drugs based on antibodies found in llamas, said an experimental rheumatoid-arthritis medicine licensed to Pfizer was found effective in a mid-stage clinical study. Ablynx said in a statement that injections with "80 milligrams of ozoralizumab every four weeks reduced the incidence of swollen joints in patients with rheumatoid arthritis after 16 weeks compared with placebo."

Comment: Llamas?????

Heavy Coffee Drinkers May Have Reduced Risk For Prostate Cancer
Nicole Ostrow writing in Bloomberg News reported that men who consumed "six or more" cups of regular or decaffeinated coffee also had a "60 percent lower risk of developing deadly metastatic prostate cancer," and one to three cups "cut the risk of lethal prostate cancer by 30 percent." The findings suggest "non-caffeine elements in coffee" may provide the benefit. Coffee contains "compounds that can reduce inflammation," the study authors noted. According to Steven Reinberg in Healthday, lead researcher Kathryn Wilson, PhD, pointed out that coffee is a "major source of antioxidants that might have anti-cancer effects,"

Comment: If you drink that much coffee you better be either near a bathroom all the time or wear a catheter.

Baby Boomers Leading the charge to Hip, Knee Replacement Surgeries
The Associated Press reports, "Knee replacement surgeries have doubled over the last decade and more than tripled in the 45-to-64 age group, new research shows. Hips are trending that way, too." In 2009, there were 288,471 total hip replacements, " nearly half of them in people under 65, according to the federal Agency for Healthcare Research and Quality, which tracks hospitalizations. Knee replacements soared from 264,311 in 1997 to 621,029 in 2009, and more than tripled in the 45-to-64-year-old age group." Dr. Nicholas DiNubile, a surgeon and a spokesperson for the American Academy of Orthopaedic Surgeons, said, " 'The boomers are the first generation trying to stay active in droves on an aging frame' and are less willing to use a cane or put up with pain or stiffness as their grandparents did."

Comment: How true… but hopefully stem cells may make joint replacements a thing of the past.


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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 June 2011

This past month, I bought a bicycle. Let me tell you the story behind it…. Some good friends had come in from out of town and they were visiting their daughter and invited us to join them for brunch in Annapolis.

After lunch my wife and I went exploring and since there were a lot of stores, we decided to shop a bit. Our first visit was to Whole Foods. Gigantic store with tons of wonderful food. .. But we didn’t get anything.

My better half then wanted to go to the Anthropologie store. I wasn’t keen on that so I wandered into Eastern Mountain Sports, which is an outdoorsy kind of store.

They were having a huge sale and I like outdoors stuff so I decided to check things out. After walking around a bit, I didn’t see anything that grabbed me so I walked outside. On the sidewalk in front of the store, they had a display of other sale items including bicycles.

Now… keep in mind, I was not looking for a bicycle. I have to admit that in the back of my mind, I was thinking about alternatives to running, which was beginning to cause more injuries… after all I’m 61.

So there I was slowly meandering my way to the Anthropologie store to meet my wife (and probably sit around for half an hour as she continued to shop) when I a bicycle on display, caught my eye. It was a very nice bicycle and I saw that it was half off, prompting me to ask why. The young man who was watching the bikes and assisting people with the sidewalk sale replied, “It’s last year’s model.”

He then asked, “Would you like to try it?” I really didn’t have a reason to try it… but then again I didn’t have a reason not to either. So I asked, “How do you know what size a bike should be?” He replied, “How tall are you?” I said 5’7”. He said, “If you stand with the bike between your legs and lift the bar up, there should be about two inches of distance from the ground…. Here, let’s look.” Well, I agreed and the bike fit perfectly. He then said, “Why don’t you take it out for a spin. Let me get you a helmet.”

So I put the helmet on, and after a few instructions, took a ride. It’s been a while since I was on a bike, so it took some getting used to but it was nice.

Then our friends that we had had brunch with earlier showed up because they were looking for a bike for their daughter. Howie, the husband, is an avid cyclist, so I asked him, “Howie, what do you think?” He looked at the bike and said, “Nice equipment… it’s built well. And then I showed him the price tag. Howie looked up, amazed, and said, “Wow, that’s a great price.” I then asked Howie if he wouldn’t mind taking it for a spin since he’s about my size. So he did and when he came back, he said, “Nice… and the price… you can’t beat it.”

So that’s how I made the decision to buy a bike.

And now that I’ve had it and been able to ride it, I’m very happy with it. I can see how cycling is good exercise and is particularly good for people with arthritis who want to avoid impact to their joints. So I guess it was fate. The rheumatologist gets a bike and discovers firsthand why something like this is good for his patients.

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