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Insider Arthritis Tips May and June 2016
June 15, 2016

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Find the magic in life; Laughing with close friends; A beautiful flower; The smell of a home cooked meal.  For these are the moments that matter most.

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African tusker dies of arthritis

Reported in the Times of India… Timbo, an African tusker that lived for four decades at My suru Zoo, died of illness early on Wednesday. Its mate had died seven years ago.

The zoo is now left with one Afric an tusker, aged 20, and eight Asian elephants. Timbo was the main attraction for four decades because of its majestic look and wide ears.

Three expert vets, including one from Kerala, were assisting zoo authorities in treating the tusker suffering from chronic arthritis.

Dr Khadri, Dr Jacob Cheeran, an elephant expert from Kerala, Dr Dhanalakshmi, assistant professor, Veterinary College, Shivamogga, were taking care of the tusker. Khadri had visited the zoo to check its health while the other two were assisting through a network.

Comment: Well… are you surprised?  I’m not…


Coffee Can Prevent Alcohol-Related Cirrhosis

Amy Jacob writing in MD reported the benefits of coffee consumption have long been questioned, but now a new group of experts have given it the thumbs up.
According to a review of studies published in the journal Alimentary Pharmacology and Therapeutics, increasing coffee intake could help reduce the chances of developing alcohol-related cirrhosis.
To examine the relationship between coffee consumption and the risk of cirrhosis, a research team led by Oliver Kennedy, MD, Southampton University in Britain, analyzed nine studies involving more than 430,000 participants.
Overall, the studies included 1,990 cirrhosis patients.
The length of the studies varied, but one lasted nearly 20 years.
In eight of the nine studies analyzed, increasing coffee consumption by two cups per day was “associated with a statistically significant reduction in the risk of cirrhosis” – specifically by 44%.

Comment:  coffee has been shown other studies to benefit the heart.  Now this.  Interesting.


Drugs that May Induce Raynaud's

Dr. Jack Cush writing in Rheum Now reported a systematic review by Khouri examined the extent drugs are capable of inducing Raynaud's phenomenon (RP).

The authors found 12 different classes of drugs responsible for RP, with cisplatin and bleomycin having with the greatest risk, followed by beta-blockers. The Framingham heart study found beta-blocker use was the most common cause of secondary RP (34.2% of secondary RP). A 2012 meta-analysis found a prevalence of 14.7% of RP in patients receiving beta-blockers.

Other less frequently cited causes include clonidine, ergot alkaloids, bromocriptine, ADHD drugs (methylphenidate  and  dextroamphetamine), phentermine (for weight loss), cocaine, vinyl chlorid exposure, and interferon therapy. 


Do Bisphosphonates Increase Risk of Carpal Tunnel Syndrome?

Lara Pullen writing in the Rheumatologist reported increasingly, postmenopausal women are prescribed bisphosphonates in an effort to prevent osteoporotic fractures. The increased prevalence of bisphosphonate use likely reflects both demographic trends toward an older female population, as well as concerns about the safety of an alternative treatment for osteoporosis: hormone replacement therapy.

Unfortunately, bisphosphonates are not without risk. In 2008, the FDA issued an alert that highlighted the association between oral bisphosphonates and incapacitating bone, joint and/or musculoskeletal pain. In 2015, the FDA issued yet another alert: warning that the use of bisphosphonates is associated with an increased risk for developing osteonecrosis of the jaw. Researchers have also noted that patients taking bisphosphonates experience an increased risk for arthritis and corresponding arthralgia. Now, investigators report that postmenopausal women who use bisphosphonates are also at increased risk for carpal tunnel syndrome.

Comment: what a list of side effects.  These drugs might be useful but be careful.


Titanium Dioxide Additives May Boost Intestinal Inflammation

David Douglas writing in the Reuters reported mouse  studies suggest that titanium dioxide (TiO2) nanoparticles, widely used as food additives and in drug formulations, may be involved in intestinal inflammation, according to Swiss researchers.

As Dr. Gerhard Rogler told Reuters Health by email, “It seems that titanium dioxide nanoparticles are not harmful for a healthy person with a normal intestinal barrier. But this may be different in an individual with impaired intestinal barrier function, such as patients with inflammatory bowel disease.”

In a paper published in Gut (like the tile of that journal), Dr. Rogler and colleagues at the University of Zurich note that IBD is increasing in many nations undergoing westernization. Among possible causes are microparticles of agents such as Ti02, which are used to improve the appearance of products including food.

The researchers go on to point out that there is increasing evidence that exposure to TiO2 “can cause adverse effects, including the production of reactive oxygen species (ROS) inflammatory responses and tumor formation.”

Comment: You are what you eat.  If that’s the case, then you’re probably a piece of titanium.


Tattoos Could Help Boost Your Immune System

Amy Jacob writing in MD reported tattoo aficionados who appreciate the creative license behind professional inking can now take solace in the potential health benefits of tattoos.
Researchers have found that getting tattoos could strengthen the immune system, helping fight common infections.
According to recently reported statistics, approximately 14% of Americans have at least one tattoo and spend nearly $1.65 billion annually on getting inked.
Typically the common associations between tattoos and any medical report have been regarding allergic reactions or skin infections. And, more seriously, healthcare professionals had found contaminated tattooing equipment could transfer blood borne diseases like tetanus and hepatitis B and C.  
However, a recent study published in the American Journal of Human Biology indicated that the immune-boosting effect increases with multiple tattoos.
Christopher Lynn, PhD, associate professor of anthropology at the University of Alabama, Tuscaloosa, AL, and team studied 29 individuals between 18-47 years old who were receiving tattoos at one of three tattoo studies in Leeds and Tuscaloosa, AL, between May-December, 2012.
The researchers collected the individuals’ saliva samples before and after the tattooing procedures to measure levels of immunoglobulin A – the antibody primed for first line of defense against common infections.
The study also assessed information regarding the total number of tattoos for each participant, lifetime hours spent receiving tattoos, etc.
The team was not surprised to discover those participants who were receiving their first tattoos showed a significant reduction in their immunoglobulin A levels – ironically a response to an increase in cortisol triggered by the stress and pain often associated with getting tattoos.
Interestingly, Lynn noted that even though the first tattoo could make the individual more susceptible to catching a cold, subsequent tattoos sessions help the body adjust its immune defenses.

Comment: Interesting finding I think.

Acetaminophen may have little effect on osteoarthritic pain

 Melissa Healey writing for the Los Angeles times reported that investigators analyzed data from 74 trials of pain medications. The data, published in the Lancet, indicated that “in older patients with osteoarthritis, acetaminophen provides no more pain relief and improvement in day-to-day function than does a placebo.” The researchers also found that several non-steroidal anti-inflammatory drugs (NSAIDs) had high probabilities of improving arthritis pain of the hips and knees.


Comment:  No surprise here.

What if your doctor gave you the bad news that you had rheumatoid arthritis and were going to be crippled?  The science says otherwise.  According to some recent data, you actually have some good news… next

Rheumatoid Arthritis Progression Rate Has Halved Since 1990

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Antibodies in Infliximab-Treated Patients Bind CT-P13

Janis Kelly writing in Medscape reported the natural history of rheumatoid arthritis (RA) has changed dramatically since 1990, apparently as a result of advances in RA treatment, such as the use of biologicals and more aggressive "treat to target" clinical approaches. The annual progression rates in studies of long-term progression reported after 1990 were less than half those reported in the prior 25 years, researchers report in an article published in the journal, Rheumatology.

Comment:  When I talk with my patients with rheumatoid arthritis I tell them it’s actually a good diagnosis to have since the likelihood of going into remission is quite high.

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.



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.


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.



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.

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Asparagus Risotto with Crispy Shallots

Recipe by Marcus Beans for
Serves 4 Preparation 5 mins Cooking 35 mins


  • 5 shallots
  • 1 clove of garlic
  • 1tsp olive oil
  • 75g of unsalted butter
  • 250g good quality Arborio risotto rice
  • 200ml of a good quality dry white wine
  • 750ml of vegetable stock
  • 8 asparagus spears
  • 150g parmesan
  • 1 lemon
  • Sea salt crystals
  • Black pepper
  • 2 tbsp of freshly chopped chives
  • 100ml of heavy cream
  • 50ml milk
  • 1tsp self-rising flour


  1. To make your risotto base finely slice 3 shallots, crush and finely chop your garlic and add to a pan with the oil and butter. Allow to soften, then add your dry risotto rice and stir until the rice is coated in the butter. Add the wine to the rice and stir until it has been absorbed.
  2. In a separate pan heat the vegetable stock. When the rice has absorbed the wine add the stock a small ladle at a time, allowing it to absorb before adding the next ladle. Keep stirring the rice to stop the risotto from sticking and to make sure it cooks evenly. Continue to do this until you have used most of the vegetable stock.
  3. To finish the risotto, chop the asparagus into small pieces keeping the tips whole and add to the risotto. Add the remaining hot stock, stir together and allow to cook for 5 minutes. Then add the parmesan, some freshly squeezed lemon juice, a touch of sea salt and pepper, stir and taste. Add the chopped
  4. chives and the cream, taste again. If you're happy with the flavours and seasoning, serve straight away.
  5. For a nice crunch finely slice some shallots so you get small rings, place in the milk, then dust in the self-raising flour. Mix then drop into some hot vegetable oil at about 180˚C. Fry until golden, remove and rest on some kitchen paper, season and sprinkle over the top of your risotto.

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Wei's World

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Concentrate on what counts

I was a zoology major in college.  Other than sports, pretty much all I did was study.  In order to fulfill the requirements to apply to medical school I took many different courses.  One course I didn’t take was Philosophy. I’m not quite sure why I didn’t but I suspect my bias was that the classes were taken by long haired unkempt, SDSers who quoted Kant, Nietsche, and the “Hegelian dialectic” whenever and wherever possible.

What I have been since I was a child is a voracious reader.  That has never stopped.  In addition to medicine I‘ve read books on history, business, marketing, negotiation, and so on.

But until recently, I had yet to study philosophy.  That changed when I read Will Durant’s “Story of Philosophy.”  While I was not completely sold on philosophy as being as entertaining as ESPN’s “30 for 30”, I realized this was a topic I had ignored for many years because of an inherent prejudice.

Now that I’ve been in practice for many years, I have found that philosophy is a topic that is surprisingly appealing.  In particular, the writings of the Roman philosopher, Epictetus, have resonated.

Epictetus was born a slave and studied under one of the great Stoic philosophers Gaius Musonius Rufus.  Eventually, Epictetus’ name became synonymous with that branch of philosophy.  In a nut shell, what Epictetus preached was this: Control what you can; cope with what you can’t; and concentrate on what counts.

In today’s environment of medicine, that philosophy has become indispensable to me.  I have no control over what Medicare or insurance companies decide… what I can control is my response.  It is the same philosophy that helped Victor Frankl survive the Nazi concentration camps, described beautifully in his book, “Man’s Search for Meaning.”

As physicians, we can control what we can control.  To worry and wring our hands about things outside of our control only adds to our angst and makes us miserable.

I encourage you to get a copy of “The Art of Living”.  It is a short collection of Epictetus’ work and is a quick and worthwhile read.

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