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Insider Arthritis Tips May and June 2015
March 15, 2015

“You don’t have to be great to start, but you have to start to be great!” Zig Ziglar

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So… which treatment for RA that works on an “as needed” basis? Find out next…

As-needed Rituxan delays need for retreatment, disease flares in patients with RA

Reported in Healio, among patients with rheumatoid arthritis, a significant proportion of those who underwent a treatment-as-needed regimen with rituximab were found to have delayed need for retreatment and disease flare, according to study findings.

The observational study included medical records data for 151 patients with rheumatoid arthritis (RA) who were treated with rituximab and followed up for at least 12 months after the onset of treatment. Most patients were concurrently taking a disease-modifying anti-rheumatic drug (DMARD). Median disease duration was 15 years. The study was published in the Journal of Clinical Rheumatology.

Comment: The decision when to give Rituxan is complicated.  Most rheumatologists go with a six month schedule.  This “treatment as needed” schedule is very appealing.

Mighty mouse breakthrough… next

Bone stem cells shown to regenerate bones and cartilage in adult mice

Reported in Science Codex, a stem cell capable of regenerating both bone and cartilage has been identified in bone marrow of mice. The discovery by researchers at Columbia University Medical Center (CUMC) was published in the journal Cell.

The cells, called osteochondroreticular (OCR) stem cells, were discovered by tracking a protein expressed by the cells. Using this marker, the researchers found that OCR cells self-renew and generate key bone and cartilage cells, including osteoblasts and chondrocytes. Researchers also showed that OCR stem cells, when transplanted to a fracture site, contribute to bone repair.

"We are now trying to figure out whether we can persuade these cells to specifically regenerate after injury. If you make a fracture in the mouse, these cells will come alive again, generate both bone and cartilage in the mouse--and repair the fracture. The question is, could this happen in humans," says Siddhartha Mukherjee, MD, PhD, assistant professor of medicine at CUMC and a senior author of the study.

Comment: great news on the stem cell front.

Does fish oil really work for RA? Maybe…

Fish oil for RA: Treat to target?

Nancy Walsh writing for MedPage Today reported patients with early rheumatoid arthritis receiving "triple therapy" with conventional disease-modifying anti-rheumatic drugs (DMARDs) were less likely to respond inadequately when given supplementary fish oil, Australian researchers found. After a year of treatment, 10.5% of patients receiving fish oil were considered treatment failures, compared with 32.1% of those not receiving the supplement, according to Susanna M. Proudman, MD, of the University of Adelaide, and colleagues.

Comment: I’m not a real fan of triple therapy.  That’s using a combination of methotrexate, Plaquenil, and sulfasalazine.  I think biologics work much better and have fewer potential side effects. Fish oil helps with RA regardless of what you take.



Popular Nerve Pain Medicine Has Little Effect On Back Pain.

Sonja Elmquist writing in Bloomberg News reported that Pfizer Inc.’s best-selling drug, Lyrica (pregabalin), “didn’t help patients with the most common cause of back pain,” severe lumbar spinal stenosis, “any more than a placebo in a small study.” The study’s findings, published in the journal Neurology, casts “doubt on the potential for doctors to expand the medication’s use.” The FDA “has not approved the drug’s use for spinal stenosis,” but Lyrica “and similar medicines are often used to treat lower back pain.”


Comment: I don’t use Lyrica for back pain.  It is helpful for peripheral neuropathy and shingles pain though.

A predictor for treatment success in rheumatoid arthritis… next.

As Needed Rituxan for RA


Diana Swift writing  in MedPage Today reported  in early rheumatoid arthritis (RA) the most important single predictor of achieving an absolute or a relative patient-perceived pain improvement (PPSI) after 6 months of treatment is baseline symmetrical arthritis, according to a Dutch study published online in the journal Rheumatology.

Comment: I’ve actually noticed the same phenomenon in my practice.

Another complication of severe psoriasis… next

 Psoriasis severity linked to hypertension

Whitney McKnight writing in Rheumatology News reported on findings from a University of Pennsylvania study.  In it investigators found that the more severe a case of psoriasis, the greater the likelihood of uncontrolled hypertension.  The study was published in JAMA Dermatology.


Comment: Patients with moderate to severe psoriasis should have blood pressure monitored closely.




Toy boat toy boat toy boat… next

Study finds spike in toy-related injuries.

Muir reporting in ABC World News  stated that a study published in the journal Clinical Pediatrics has found “a spike in toy-related injuries, up 40 percent in the last 24 years,” with one US child having to go to the emergency department “every three minutes.”


Comment: When I was a kid, one Christmas, my parents got my brother and I a Cape Canaveral rocket set with spring loaded missiles.  We had a ball chasing each other around and shooting them at each other.




Yoga makes you smarter

Reported in the Daily Burst, in a recent eight-week study, adults over age 55 who took an hour- long class of hatha yoga (the most commonly practiced form of yoga worldwide) three times a week had significantly better memory and attention than adults who simply did stretching and toning exercises.

Neha Gothe, PhD, assistant professor of kinesiology, Wayne State University, Detroit and colleagues asserted, “. “The focus required to hold poses and control breathing during yoga may result in better attention to mental tasks as well.”

Comment: I take yoga.  I’m not sure I’m smarter because of it but it definitely makes me feel better.

Are you feeling sluggish? ~ Do you have trouble finding energy just to do everyday tasks? ~ Do you wish you had just a little more energy to accomplish more in your day?

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  • Promotes endurance and positive mood
  • Works to combat exhaustion due to adrenal gland health
  • Eases feelings of being overwhelmed
  • Helps fight stress
  • Promotes healthy adrenal hormones
  • Fosters healthy immune system function·
  • Lifts that "run-down" feeling
  • Contributes to the metabolism of carbohydrates and fatty acids
  • Enhances quality of life and well being

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Blueberry Oat Pancakes with Maple Yogurt

Prep Time: 5 minutes ~ Cook Time: 10 minutes ~ Yield: 2 servings of 3 (3-inch) pancakes and about 1/2 cup yogurt mixture


  • 1 cup old-fashioned rolled oats
  • 1/2 cup low-fat cottage cheese
  • 2 large eggs
  • 1 teaspoon vanilla extract
  • 1 cup blueberries
  • Cooking spray
  • 3/4 cup plain Greek-style low-fat yogurt
  • 1 tablespoon maple syrup
  • Preparation
  1. Combine oats, cottage cheese, eggs, and vanilla in a blender or food processor. Process until smooth. Gently stir in blueberries.
  2. Heat a large nonstick skillet over medium heat. Coat pan with cooking spray. Spoon about 2 tablespoons batter per pancake into pan. Cook 3 minutes or until tops are covered with bubbles and edges look cooked. Carefully turn pancakes over, and cook 3 minutes until golden.
  3. Combine yogurt and maple syrup; serve over pancakes.

12 Unexpected Benefits of Pineapple You Need To Know

Food and Drink Lifestyle by Allison Renner

Pineapple is that delicious fruit, great for salads, drinks, or just by itself – pineapple is still a delicious fruit. But did you know that it has many unexpected benefits?

  1. It’s packed with vitamins and minerals. Check out the goods on pineapples: they’re loaded with vitamin A, vitamin C, calcium, potassium, and phosphorus. While it’s rich in fiber and calories, it’s low in fat and cholesterol. Pineapples are a great, nutritious fruit to add to your diet to improve and maintain your health.
  2. It strengthens bones. Pineapple contains manganese, a mineral necessary for your body to build strong bones and connective tissues. One cup of pineapple gives your body 73 percent of the manganese it needs!
  3. It improves digestion. Bromelain is an extract found in pineapple stems, and works to neutralize fluids to make sure they’re not too acidic. Bromelain also regulates the pancreatic secretions that aid digestion. You can keep your digestive tract healthy because it is high in protein-digesting properties.
  4. It keeps gums healthy. You brush your teeth several times a day, but do you pay attention to your gums? Because pineapple has such a high vitamin C content, eating the fruit lowers your risk of gingivitis and periodontal disease. The more vitamin C in your diet improves your body’s ability to fight invading bacteria that contributes to these diseases.
  5. It alleviates arthritis. Pineapple has anti-inflammatory qualities, so including the fruit in your diet can alleviate the pain of arthritis, along with similar conditions, like gout and carpal tunnel syndrome. It also can help improve the condition overall by strengthening your bones.
  6. It prevents hypertension. If you’re trying to ease your high blood pressure, or want to avoid getting it, then eat a lot of pineapple. Because pineapples have a high amount of potassium and a low amount of sodium, your body will maintain normal blood pressure levels.
  7. It has anti-cancer properties. There might not be a cure for cancer, but there are things that can help you prevent it, and pineapple is one of those things. Because pineapples are so full of antioxidants, they help fight against free radicals.
  8. It prevents coughs and colds. The pineapple is rich in vitamin C, which means it naturally boosts your immune system. This helps you fight off coughs and colds.
  9. It lowers risk of macular degeneration. Macular degeneration is caused by damage to the retina, and is the primary cause of vision loss in adults. If you add pineapple in your regular diet, you can lower your risk for this disease by up to 36 percent! This is because pineapple is full of beta carotene, which is good for your sight.
  10. It stays fresher longer. After bringing your pineapple home from the store, you can keep it on the counter at room temperature for a day or two before cutting. If you’re not ready to eat the pineapple after two days, wrap it in plastic and it will stay good in the refrigerator for three to five more days. Once you cut up the pineapple keep it in an airtight container in the fridge and it will stay good—and nutritious!—for six to nine days!
  11. It’s a good weight loss food. Pineapple has a delicious, natural sweetness that makes it taste like a dessert on its own. As an added bonus, pineapple is low in calories, sodium, cholesterol, and saturated fats, while being a good source of fiber. This makes it the perfect weight loss food because it’s a healthy, filling, and tasty snack!
  12. It relieves nausea. A key benefit from pineapple juice intake is that it averts nausea or morning sickness. This is quite useful for pregnant women who usually experience nausea. It also helps people who are looking to go on airplane trips that usually cause motion sickness.

Signs You're Sleep Deprived

by Rachel Swalin

People's needs vary when it comes to sleep. But what if your lack of shut eye is hurting your health?

  • Time for bed - You know you're supposed to get seven to nine hours of sleep a night, but sometimes, you stay up for a night out on the town, to finish a project at work, or even just to watch Law & Order reruns.
  • You're always hungry - "If the brain is not getting the energy it needs from sleep it will often try to get it from food," says Chris Winter, MD, owner of Charlottesville Neurology and Sleep Medicine in Virginia.
  • You've gained weight - When you're tired, you don't watch what you're eating. You may tend to look for all kinds of things to help you feel more awake, and a lack of sleep can also have direct effects on your metabolism.
  • You're more impulsive - People tend to act without thinking when they're exhausted.
  • Your memory's shot - "When you're tired, you're usually not paying a whole lot of attention to what's going on when trying to make a memory.
  • You're having trouble making decisions - If you've been finding it harder than usual to manage projects at work and home, lack of sleep could be the culprit. "Sleep deprivation can affect speed and higher-level cognitive processing," Baron says.
  • Your motor skills are off - Yes, tripping over a step might make you a klutz. But do it a few times in a day and it might just mean you're too tired to really focus on where you're going. "When you're tired, there's a lapse in how you neurologically function in general," Dr. Winter says.

Seven foods that fight sun damage

Tiffany Gagnon 8/12/2014

Don't Get Burned

The spotlight on sun damage is burning brighter today than ever before. Not only do we know more about the harmful effects of the sun, but also we have more information and products available to help fight back. Of course, keeping out of the sun, covering up exposed skin, and wearing a good sunscreen are your best bets for protecting yourself against harmful rays, but there is one line of defense you could be forgetting: your grocery cart.

  • Sweet Potatoes - Cancer-causing compounds called free radicals are the enemy when it comes to sun damage. They not only cause damage to skin cells, but also cells inside the body. One of the best ways to help your body fight off free radicals is eating antioxidant-rich foods. A powerful antioxidants is beta-carotene. Sweet potatoes are packed to the brim with beta-carotene, so chow down this summer!
  • Green Tea - Green tea is often applauded for its ability to rev up your metabolism, but it's also a powerful skin food. Green tea contains a high concentration of catechins, which boast anti-inflammatory, anti-aging, and antioxidant effects that fight off free radicals from the sun. It also contains polyphenols, plant compounds that some studies suggest may be effective in preventing cancer because they limit the blood supply to different areas where cancer can develop, explains Carrillo. “Shy away from bottled, processed teas because the polyphenol count changes once it’s been on the shelf--it's lower," warns Carrillo. "Brew fresh tea instead.”
  • Sunflower Seeds - These crunchy little seeds contain the powerful antioxidant vitamin E. One ounce of hulled sunflower seeds contains about 10 milligrams, which is about two-thirds of your recommended daily intake. Sprinkle over salads, mix into oatmeal, or eat by the handful. It's best to get your dose of vitamin E from whole foods, versus supplements, to reap the most benefits. Other potent sources include nuts, eggs, green leafy vegetables, avocados, and whole grains
  • Tomatoes - Lycopene is another important antioxidant to have in your diet regularly, especially during the summer. Tomatoes are one of the best sources. The redder the tomato, the more lycopene it contains. Lycopene is more easily absorbed by your body when the tomatoes have been cooked, so reach for tomato paste, juice, soups, and sauces pre-beach day.
  • Salmon - While antioxidant-rich foods are central to protecting your skin against the sun, it’s also important to consume healthy fats. Foods like salmon, tuna, walnuts, and flaxseed are all good sources of omega-3s and will help maintain that healthy layer of fat underneath the skin and prevent skin damage and aging.
  • Asparagus - Asparagus is another great source of vitamin E! The green stalks are one of the most effective foods when it comes to neutralizing cell-damaging free radicals.
  • Water - Water, water, and more water. The sun dehydrates you, and dehydrated skin is more sensitive and prone to damage. “Your body is mostly water, so by staying hydrated, you’re making your skin healthier," explains Carrillo. "It’s going to prevent loss of moisture, which makes skin wrinkly. Good hydration is essential.”

Wei's World, January 2015

Mary Elizabeth Dallas, writing for Healthday reported on a British study showing being bullied as a child may take a larger toll on a young adult's mental health than being abused or neglected at home.

She wrote, “… Children who were bullied by their peers were about five times more likely to develop anxiety compared to those who were mistreated by their parents or other adults. Kids who were bullied were also nearly twice as likely to self-harm and have more symptoms of depression at 18 as those who had been mistreated by adults, the study found.”

I read this article with tears in my eyes. I was bullied in junior high school. Every day after school, the same four older kids would wait for me as I walked home. They would take turns shoving me, emptying books and papers from my book bag, taunting me, calling me names, sometimes slapping and punching me, and just making my walk home from school something I dreaded.

When I went to high school, I also encountered bullying when I was on the football team.

I first started getting treated for depression when I was a fellow at the National Institutes of Health. So… basically I’ve undergone therapy and medications for almost 40 years. Has my depression been entirely due to bullying? Probably not since I grew up in a somewhat dysfunctional household and there was a history of mental illness.

Yet, the bullying still hangs like a malignant spirit in my memory, often shoving aside the pleasant memories of childhood. At different times I still feel anger and frustration for no apparent reason. Much of it is directed against my former tormentors. But much of it is also directed against myself and even my family members for not having the courage to fight back.

The bullying did have two positive effects. First, it forced me to look inward and focus my anger and frustration on my studies. Like a magnifying glass penciling the rays of the sun. Even now, while I’m considered one of the best in my field, I keep trying to get better because there’s always room for improvement. Those memories, as disturbing as they are, push me every day.

One other benefit of the earlier bullying is that it has given me resilience. My inner spirit is stronger. As an adult, I refuse to be bullied by anyone or anything.

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