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Insider Arthritis Tips July and August 2016
July 15, 2016
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"The Greatest Danger For Most Of Us Is Not That Our Aim Is Too High And We Miss It But That It Is Too Low And We Reach It."  Michelangelo

 


This popular drug is useless in

This popular drug is useless in osteoarthritis

Acetaminophen Ineffective in Osteoarthritis

Jennie Smith writing in Rheumatology News reported on a study published in the Lancet. Researchers showed that the results of 74 randomized trials enrolling nearly 60,000 patients with osteoarthritis of the hip or knee were surprising. When compared with standard non-steroidal anti-inflammatory drugs, acetaminophen had virtually no effect on pain symptoms.

Comment: Acetaminophen is useless in osteoarthritis. We have suspected this for a long time and we now have definitive proof.

A commonly used over the counter drug causes dementia… next

Anticholinergic Medications May Be Linked To Increased Dementia Risk

Mandy Oaklander writing in Time reported  researchers “analyzed already existing data from 451 people around ages 70-75 who had normal brains,” then “examined the results of memory tests, MRI brain scans and other neuroimaging data – all while paying particular attention to people who said they took anticholinergic” medications. Seniors “who regularly took at least one anticholinergic drug- sold over the counter and by prescription as sleep aids and for chronic diseases including hypertension, cardiovascular disease and chronic obstructive pulmonary disease according to Ben Tinker of CNN- showed poorer cognition, lower brain volumes and less glucose metabolism in the whole brain and the temporal lobe” than seniors who did not. The study was published online in JAMA Neurology.

Comment: Wow. The list of what we can take that doesn’t cause bad side effects is shrinking fast.

Uric acid lowering therapy is important for patients with symptomatic gout. However, for certain groups there is a risk of treatment… next

HLA-B*5801 Testing Needed in Asians and Blacks with Gout

Dr. Jack Cush in Rheum Now reported on a study by Choi and colleagues who analyzed US hospitalizations (2009–2013) to assess the frequency and racial distribution of patients hospitalized with Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) related to the use of urate-lowering (ULT) therapy (predominantly allopurinol). They found 606 hospitalizations while receiving ULT. There was an overrepresentation of Asians (27%) and Blacks (26%), and an underrepresentation of Whites (29%) and Hispanics (% too low to report).

These SJS/TEN events were 12 time more frequent in Asians, and 5 times more frequent in Blacks when compared to Whites (reference group).
The HLA-B*5801 allele has been strongly linked with the allopurinol hypersensitivity syndrome and has been found in higher frequency in certain populations, especially Koreans, Japanese, Thai and Han Chinese - and in some Europeans. This study demonstrates the potential use of HLA-B*5801 in U.S. Asians and Blacks.

Comment: Really important info to know when treating certain racial groups with gout.

 

Disturbing risk of knee replacement… next

Heart Attack After Total Knee Replacement

Bruce Jancin writing in rheumatology News reported on a British study of more than 13,000 patients who underwent total knee replacement. A matched nonsurgical group was used as control. During the first month after knee replacement, there was an almost 9 fold increase in the risk of heart attack compared with the control group. At 3 months the risk was four times greater and at 6 months 2 times greater. Another finding was that the risk of venous thromboembolism- a blood clot that goes to the lungs- remained elevated for 5 years.

Comment: Wow… not good news for you if you want to have a knee replaced.

Changing your gut bugs may be the next step in the future of medicine…

Pharmaceutical Companies Considering Potential of Treating Microbiome

Elizabeth Preston writing in STAT reported that “as scientists learn more about the microbiome’s role in conditions ranging from allergies to anxiety to cancer,” pharmaceutical companies are “paying close attention.” The goal of such research is to “treat or prevent some of our most intractable diseases” by “delivering drugs to the microbiome.”

The microbiome has generated a ton of interest in researchers across all disciplines. It will be interesting to see what happens over the next few years.

New osteoporosis drugs work well but may worsen rheumatoid arthritis…

Anti-sclerostin osteoporosis drugs worsen RA

Jeff Evans writing in Rheumatology news reported antisclerostin antibodies increase bone mineral density and have done well in clinical trials in osteoporosis. However, they may have the opposite effect in rheumatoid arthritis according to a German study. Researchers showed these drugs accelerate joint damage in mouse models of rheumatoid arthritis.

Comment: Often, new drugs aimed at helping one condition can worsen another.

Shingles Vaccine… when to give it… a Conundrum

Expert advice about shingles vaccine in rheumatoid arthritis

Bruca Jancin writing in Rheumatology News reported on a lecture given by Dr. John Cush at the Winter Rheumatology Symposium. While the recommendation is against giving zoster vaccine to patients on biologics, Dr. Cush did a survey of more than 200 patients inadvertently given the vaccine while on biologics. Not one case of shingles occurred. A study conducted in Alabama of 633 patients on biologics given inadvertent zoster vaccine also failed to show an increase in shingles risk and actually showed a 39% reduction in shingles risk.

Comment: Reassuring news that shingles vaccine, even though it is live, is not the end of the world if given to patients on biologic therapy. That being said, I still think that a 4 week waiting period before vaccination while holding a biologic is prudent.

Good news for tequila drinker next…

Tequila Could Be the Basis for a New Osteoporosis Treatment

Caitlyn Fitzpatrick writing in MD reported in addition to being the most important ingredient in margaritas, substances derived from tequila can play an important role in health.
Not only did new research find that Agave tequilana (or tequila agave) may help maintain bone health, but it could also be the basis for a new osteoporosis treatment. Mercedes López, PhD, led the project at the Center for Research and Advanced Studies (Cinvestav) in Mexico.

Using animal models, the researchers induced osteoporosis in mice by removing their ovaries. The animals were then given agave fructans (polymers that store carbohydrates in some fruits and vegetables). After eight weeks, femur samples were collected in order to assess the absorption of minerals and osteocalcin (a protein that indicates new bone production).
“It was found that mice that consumed this fructans synthesized nearly 50% more of such protein, in addition that the diameter of their bones was higher compared with the subjects which were not supplied with derivatives of the agave,” López explained.

Comment: It’s getting closer to Cinqo de Mayo.


Summer Squash Casserole

Summer Squash Casserole

Foodnetwork.com

 

Prep Time: 15 minutes ~ Cook Time: 50 minutes ~ Total Time: 65 minutes ~ Yield: 4 to 6 Servings

 
Ingredients –

 

  • 2 pounds sliced yellow summer squash
  • 1/2 teaspoon sugar
  • 1 teaspoon salt
  • 4 ounces butter
  • 1 1/2 cups shredded mild Cheddar cheese or Monterey Jack, divided
  • 1 cup buttery crackers, crumbled
  • 1/2 cup evaporated milk
  • 2 eggs, beaten
  • black pepper to taste

 

Directions –

 

Boil sliced squash in water with salt and sugar until just tender. Drain well and add butter, 1 cup of the cheese, 3/4 cup cracker crumbs, milk, eggs, and pepper. Mix well and pour into a buttered 2-quart casserole or baking dish.  Sprinkle reserved cheese and cracker crumbs over the top of the squash mixture. 

 

Bake for 30 to 45 minutes at 325°.


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