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Insider Arthritis Tips November and December 2016
November 15, 2016

A Quote to be Inspired By...

When You Face Difficult Times, Know That Challenges Are Not Sent To Destroy You. They’re Sent To Promote, Increase And Strengthen You. - Unknown

What's New

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Hope for Alzheimer’s… maybe

Arthritis drug could reduce risk of having Alzheimer's disease

Nicholas Bakalar writing for Business Standard reported a drug used to treat rheumatoid arthritis may have benefits against Alzheimer's disease, researchers report.

Rheumatoid arthritis is an autoimmune disease believed to be driven in part by tumour necrosis factor, or TNF, a protein that promotes inflammation. Drugs that block TNF, including an injectable drug called etanercept, have been used to treat rheumatoid arthritis for many years.

TNF is also elevated in the cerebrospinal fluid of Alzheimer's patients.

Researchers identified 41,109 men and women with a diagnosis of rheumatoid arthritis and 325 with both rheumatoid arthritis and Alzheimer's disease. In people over 65, the prevalence of Alzheimer's disease was more than twice as high in people with rheumatoid arthritis, as in those without it. The study is in CNS Drugs.

But unlike patients treated with five other rheumatoid arthritis drugs, those who had been treated with etanercept showed a significantly reduced risk for Alzheimer's disease.

Comment: Interesting to see what future developments occur


 A popular method of relaxation is deadly. Found out which one next

Watching TV Longer Increases Risk Of Fatal Blood Clot, Study Finds

Nicholas Bakalar writing in the New York times reported a new study published in the journal Circulation by Japanese researchers analyzing “86,024 generally healthy people who filled out questionnaires with items about health and lifestyle, including time spent watching television,” found that more time watching television increases the risk for a fatal blood clot. Researchers estimated that, after adjusting for other factors, “watching for two and a half to five hours increased the risk for a fatal clot by 70 percent, and watching more than five hours increased the risk by 250 percent,” compared to watching for less than two and half hours each day.

Comment: Better grab that remote, turn the TV off and get moving…


 A novel method for detection and treatment in rheumatoid arthritis… next

Rheumatoid Arthritis Effectively Diagnosed And Treated With Biodegradable Nanoparticles In Early Study

Dr. Patricia Inacio writing in Rheumatoid Arthritis News reported biodegradable polymer nanoparticles (BNPs), tiny particles made of a biodegradable polymer, appear to be quite useful for the early detection and for long-term, effective treatment of rheumatoid arthritis (RA) with minimal side effects, according to a study presented at the recent. These particles, once coated with a molecule that specifically targets inflamed joint tissues, ensure a high degree of efficacy in delivering both diagnostic probes and drugs to arthritic joints.

Dr. Paolo Macor, the study’s lead investigator from the Department of Life Sciences, University of Trieste, Italy said “There is a need to develop a new tool to enable early diagnosis, and also to develop tissue-specific agents able to reduce systemic side effects. This would increase the potency of drugs with lower doses, and also potentially reduce the cost of treatment,” Dr. Macor said.

Comment: Exciting and I look forward to hearing more.


And your surgeon says you need surgery… maybe not… next

Meniscal Tears May Not Need Surgery

Jack Cush reporting in RheumNow cited a study published in the British Medical Journal examines whether knee surgery or conservative medical management benefits those with degenerative meniscal tears. Patients with knee pain from a degenerative meniscal tear were randomized to either arthroscopic surgery (followed by daily exercises at home) or physical therapy (neuromuscular and strength exercises) two to three times a week for 12 weeks.

Over the next 2 years both groups improved. Muscle strength had improved more, on average, in the physical therapy group at the three-month checkup, but at the final two-year checkup, there was essentially no difference between the surgery and therapy groups, including in pain, ability to function in sports and recreation activities, and quality of life. The researchers noted that 19 percent of the therapy group opted to have surgery at some point but had achieved “no additional benefit” by the end of the study.

Conservative exercise therapy was equal to arthroscopic intervention overall, but also showed positive effects over surgery short-term muscle strength.  Clinicians should consider conservative management and physical therapy in middle-aged patients with degenerative meniscal tears.

Comment: Degenerative meniscus tears are secondary to the arthritis.  Surgery is not generally warranted.


Omega 3’s…how helpful are they… more than you think

Omega-3 fatty acids from fish oil may help heart attack patients recover

Amy Kraft reporting for CBS News pointed to new research indicating that “omega-3 fatty acids from fish oil may help heart attack patients recover by improving heart function and reducing scarring in the heart muscle.” The research “involved 360 patients who received either 4 grams of omega-3 fatty acids or a placebo daily for six months after their heart attack.” Investigators “used MRI scans to evaluate their hearts before and after.”

Comment: I already take them and will continue to do so.


Brrrr.  It’s cold.  And the FDA doesn’t like it… next

FDA Says Cryotherapy Lacks Evidence, Poses Risks

Dr. Jack Cush in RheumNow reported cryotherapy is a non-FDA approved treatment that has been promoted to treat post-athletic injury, osteoarthritis, rheumatoid arthritis, fibromyalgia, alzheimers, migraines, asthma, multiple sclerosis, etc. Cryotherapy may be as simple as ice packs on a localized portion of the body, such as the lower back, or may involve whole body cryotherapy exposing the body to vapors that reach ultra-low temperatures ranging from minus 200 to minus 300 degrees Fahrenheit, typically for 2-4 minutes at a time.

But according to the FDA, cryotherapy may pose serious health risks and does not have the evidence to substantiate many of its claims. Whole body cryotherapy (WBC) is starting to pop up in a number of gyms, spas and wellness centers. 

Despite the growing availability of WBC, cryotherapy hasn't been cleared or approved by the FDA to treat any conditions. An FDA scientific reviewer said potential hazards of cryotherapy include asphyxiation, frostbite and burns.

Comment: I still advocate ice for acute injuries and for some soft tissue problems as well as osteoarthritis. It works but be cautious.


More good news on the stem cell front… next

New Treatment Shows Promise for Crippling Knee Arthritis

Alan Mozes writing for Healthday reported on a small study that demonstrated that just one injection of stem cells can reduce pain and inflammation.

The idea is experimental: Extract stem cells from a patient's own body fat -- cells known for their ability to differentiate and perform any number of regenerative functions -- and inject them directly into the damaged knee joint.

To explore the potential of stem cell therapy, the study authors focused on 18 French and German men and women, aged 50 to 75, all of whom had struggled with severe knee osteoarthritis for at least a year before joining the study.

Between April 2012 and December 2013, all of the patients first underwent liposuction to extract fat-derived samples of a specific type of stem cell. The researchers noted that these particular stem cells have been shown to have immune-boosting and anti-scarring properties, as well as the ability to protect against cell "stress" and death.

A third of the patients received a single "low-dose" injection of their own stem cells directly into their knee. Another third received a "medium-dose" injection, involving a little more than four times the amount of stem cells, while the remaining group received a "high-dose" injection packed with roughly five times as many stem cells as the medium-dose group.

After six months, the study team found that all three groups showed improvements in terms of pain, function and mobility.

However, only those in the low-dose group were determined to have "statistically significant" improvements in terms of both knee pain and function recovery.

Comment: this data is in keeping with other studies.


How toxic is methotrexate to the liver… next

Methotrexate increases risk of liver abnormalities but not serious liver damage

Amy Karon writing in Rheumatology News reported that methotrexate use doubled the risk of liver enzyme abnormalities but was not ties to serious outcomes in patients with rheumatic disease, according to a meta-analysis of 32 randomized controlled trials. The study examined more than 13 thousand patients and was published in Seminars in Arthritis and Rheumatism.

Comment: methotrexate is our workhorse drug for many rheumatic conditions.  It’s comforting to know that the liver toxicity profile is not serious.


Not all the news about non-steroidal drugs is bad. In fact, this next item might surprise you…

Decreased Risk of Dementia With Prolonged NSAID Exposure in RA

Lauren Grygotis writing in Neurology Advisor reported a longer period of treatment with non- steroid anti-inflammatory drugs (NSAIDs) was associated with a decreased risk of dementia among patients with rheumatoid arthritis (RA) in a large population-based cohort, according to recent findings published in Medicine.

Previous studies have suggested that early inflammation, cardiovascular disease, and depression are associated with increased risk of dementia.  The authors of the study noted that NSAIDs are “commonly used for treating RA, and several studies suggest that NSAIDs reduce the risk of Alzheimer’s disease or dementia in patients with RA.”

Comment: Interesting


An over the counter preparation that could be life-threatening… next

FDA warns OTC antacids with aspirin can cause stomach or intestinal bleeding

Lydia Wheeler writing in The Hill reported that the Food and Drug Administration “is warning consumers to beware of over-the-counter drugs that contain both an antacid and aspirin.” According to the agency, these products “can cause stomach or intestinal bleeding.” Although rare, the FDA says it has identified eight cases of serious bleeding since 2009.

Comment: Not a big surprise here. In the old days when we used high doses of aspirin, people would get bleeding ulcers frequently.



For patients with inflammation of the eye, which is the best anti- TNF drug?  Next

Humira tops others for patients with ankylosing spondylitis and anterior uveitis

M. Alexander Otto writing for Rheumatology News reported on a study from Gothenburg University involving 1,365 patients with ankylosing spondylitis.  Compared with both Enbrel and Remicade, Humira led to many fewer office visits for anterior uveitis. Flares also decreased by about 40%. Enbrel appeared to make uveitis worse.

Comment:    One of my sons who has ankylosing spondylitis had an episode of anterior uveits this past summer.  Very frightening. It is imperative to have the patient see an ophthalmologist as soon as possible.

Food For Thought

Praline Pumpkin Pie with Maple Rum SauceFrom the Kitchen of Deep South Dish

3/4 cup granulated sugar1 teaspoon ground cinnamon1/2 teaspoon salt1/2 teaspoon ground ginger1/4 teaspoon ground cloves2 large eggs1 can (15 ounce) canned pumpkin (like Libby's)1 can (12 ounce) evaporated milk1 unbaked 9-inch deep dish pie shell, homemade or prepared (Pillsbury recommended)Fresh whipped cream

Praline Topping:

1/4 cup of pure butter, softened at room temperature1/2 cup packed light brown sugar1/4 cup all purpose flour1/2 cup of chopped pecans

Maple Rum Sauce:

1/4 cup of pure butter1 cup packed brown sugar1/2 cup whipping cream2 tablespoons light rum1/2 teaspoon maple extract

Whisk together the sugar, cinnamon, salt, ginger and cloves in small bowl. In a separate bowl, beat together the eggs and stir in the pumpkin until smooth. Add the sugar mixture and slowly stir in the evaporated milk. Pour into a pie shell. Combine the praline topping ingredients and sprinkle over the pie.

Bake at 425 degrees F for 15 minutes; reduce temperature to 350 degrees F for another 45 minutes or until a knife inserted into the center comes out clean. Shield edges of crust with aluminum foil halfway through cooking time, to prevent overbrowning.

Cool completely before slicing. For the sauce, melt together the butter, brown sugar and whipping cream until mixture comes to a boil; boil and stir for 2 minutes. Remove from heat; stir in the rum and maple extract.

Wei's World

Is Medicine Still A Meritocracy?

One of my former mentors and one of the smartest people I've ever known once told me, "You know, medicine is one of the last forms of meritocracy."As my career progressed in its early stages, this statement really stuck with me. By definition, a meritocracy is a system comprised of "an elite group of people whose progress is based on ability and talent rather than on class privilege or wealth." In such a system, those "persons are rewarded and advanced."

However, as things have unwound over the years, I have begun to doubt whether my mentor's remark still holds true.

A person can have the best training and be the smartest physician in the community, yet still struggle. The source of this struggle comes from all directions, not just from the usual suspects: the government, insurance companies, lawyers, and so on. It can come from unexpected places, such as your national organization, some of your colleagues, and even yourself.

There are two powerful influences we all must deal with. The first is ego. As Ryan Holliday said in his excellent book of the same title , "ego is the enemy." It is important to realize that you may not be as good as you think you are. Just because you think you're hot stuff doesn't make it so.

The flip side of an uncontrolled ego is self-doubt. While you may not be as good as you think you are, you probably are not as bad as you think you are either.Self-doubt can seriously undermine an individual, but only if that person allows it to. Sometimes, the way to the top consists of a series of vicious fights with the winner not necessarily being the one most qualified. That doesn't mean one has to play that game. It does mean not having "doormat" stamped on your forehead.

Is medicine truly a meritocracy? I'm not sure anymore. "Meritocracy" is often determined by forces out of our control. So the lesson that we tell our kids should be the following: do the best you can and strive to get better every day. Leave no doubt in your mind that you are putting out your best effort. If you are the best you that you can be, that's good enough.

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Sea Gold… It’s the purest form of Omega-3 fish oil available.

Research studies show that the health benefits from Omega 3 fish oil are downright amazing. Omega-3 fish oils have been recommended by more rheumatologists than any other dietary supplement for the control of the inflammation that accompanies rheumatoid arthritis, psoriatic arthritis, and other forms for inflammatory arthritis. Studies show that supplementation with fish oils can markedly reduce morning stiffness and the number of painful joints for people who have rheumatoid arthritis. AndSea Gold is the purest, most effective dietary fish oil manufactured.

Omega-3 supplements may provide the following benefits to make you happier and healthier:

  • Lower blood pressure.
  • Reduce triglycerides.
  • Improve your memory and energy levels.
  • Reduce your stress and fatigue.
  • Reduces breast, colon and prostate cancer.
  • Live a strong healthier life!
  • Reduce your risk of arthritis, heart attack, stroke, and sudden death.

And now it's time to put all these Omega 3 fish oil health benefits to work by eating more oily fish and taking quality fish oil supplements every day.

Buy 2 and Get 1 Free….

This offer is available only thru December 2016. Call our office at 301-694-5800 to speak with our product specialist.

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