"We may encounter many defeats, but we must not be defeated."
-- Maya Angelou, poet
Reporting Arthritis News For June 2011
NSAID Use Risky in
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
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."
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
reported, "Rheumatoid arthritis
treatment with rituximab (Rituxan)
carries a modest risk of progressive
(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
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
Comment: A very typical pattern
that hasn’t changes since I was a
medical student. Why this time of the
day… who knows?
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
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
Debra Pressey in the
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
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
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?
For Rheumatoid Arthritis
John Martens writing in
Bloomberg News reported,
"Ablynx NV, the
developer of drugs based on
antibodies found in llamas, said an
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
Heavy Coffee Drinkers May
Have Reduced Risk For
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
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
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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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.